According to a recent study, the long-term risk for prostate cancer can be predicted from a 1-time prostate-specific antigen (PSA) test before the age of 50.

The study of more than 20,000 Swedish men indicates a PSA value above 1.5 ng/mL between the ages of 45 and 49 account for nearly half of the prostate cancer deaths over the next 30 years or so. Only 10% of the men in the study had such high PSA values at this relatively young age.

Therefore, the researchers believe that PSA values obtained in men in their 40s could allow doctors to stratify risk and identify those in the top 10% that need aggressive follow-up of either annual or biennial PSA tests.

According to current screening guidelines a lot of the men in the top 10% would be told, “You're fine.” However, in the study, 44% all of the prostate cancer deaths occurred in this top 10% of men. Current screening recommendations involving PSA testing do not involve risk stratification and suggest that biennial PSA tests starting at age 50 to age 70. This new research may challenge those recommendations.

A bigger challenge than getting high-risk young men to return to the clinic for close monitoring might be getting young men to have a PSA test in the first place. PSA testing has been in steady decline since 2003/04, when about 50% of all men older than 50 years reported being tested.

This study was similar to another study the team published in 2010 which indicated that most of the deaths from prostate cancer were among the 25% or so of men who had, at age 60, PSA levels higher than 2 ng/mL. The study suggested that repeat screening could be confined to that 25% of men whose PSA level is above 2 ng/mL at 60 years of age.

This was the first time that the researchers suggested that the PSA test offers clear recommendations for clinical practice. They asserted that risk-stratifying screening had 2 major benefits: it will reduce over diagnosis in men at low risk for prostate cancer death, and it will improve compliance with screening in men who will benefit the most.

Sources:

Medscape