By: Gayle R. Lewis, Esquire
Sources: British Medical Journal 2013;346:f2023; BBC Health News
A STUDY initiated by Sweedish researchers was recently published in the British Medical Joural. The goal of the study was to determine the association (if any) between concentration of prostate specific antigen (PSA) at age 40-55 and subsequent risk of prostate cancer metastasis (spread) and mortality (death) in an unscreened population to evaluate when to start screening for prostate cancer and whether rescreening could be risk stratified.
The resarchers conclude that PSA concentrations can indicate not only the current risk of cancer—and hence the need for prostate biopsy—but are also predictive of the future risk of prostate cancer metastasis and cancer specific death. They recommed screening on men at highest risk, with three lifetime PSA tests between the ages of 45 and 60 sufficient for at least half of the male population. This is likely to reduce the risk of overdiagnosis while still enabling early cancer detection among those most likely to gain from early diagnosis. As such, a risk stratified approach to PSA screening will improve the ratio of its benefits and harms.
The Malmö Preventive Project in Sweden looked at a large study of 21 277 Swedish men aged 27-52 (74% of the eligible population) who provided blood at baseline in 1974-84, and 4922 men invited to provide a second sample six years later. Rates of PSA testing remained extremely low during median follow-up of 27 years.
Main outcome measures Metastasis or death from prostate cancer ascertained by review of case notes.
The risk of death from prostate cancer was associated with baseline PSA: 44% of deaths occurred in men with a PSA concentration in the highest 10th of the distribution of concentrations at age 45-49 (≥1.6 µg/L). Although a 25-30 year risk of prostate cancer metastasis could not be ruled out by concentrations below the median at age 45-49 (0.68 µg/L) or 51-55 (0.85 µg/L), the 15 year risk remained low at 0.09% at age 45-49 and 0.28% at age 51-55, suggesting that longer intervals between screening would be appropriate in this group.
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