COMMENTARY

Early PSA Predicts Prostate Cancer Risk -- But Then What?

Gerald Chodak, MD

Disclosures

December 01, 2010

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Hello, I'm Dr. Gerald Chodak for Medscape. In October 2010, an article was published in Cancer Online[1] that looked at more than 20,000 men from Sweden who had their blood drawn and stored when they were between the ages of 33 and 50. Over time, through 2006, more than 1400 of the men were diagnosed with prostate cancer. The investigators went back and tested the blood samples of these men to see what their PSA [prostate-specific antigen] levels were up to 30 years before the diagnosis of prostate cancer was made. They found that if the PSA was > 0.63 ng/mL, they had a significant chance of developing cancer or advanced cancer many years in the future. This raises a question: What would you do with this information? The investigators suggest that it could help stratify men according to their risk. If they have a PSA level less than that cutoff, then they could be followed less often. However, if their PSA was above that value, then more careful follow-up would be needed.

Of course, the problem with the article is that it doesn't address the implications of testing in terms of the long-term outcomes. Although these men were diagnosed with cancer, it's unclear whether this testing process would reduce their chances of dying from the disease. The study does not address the implications for predicting which men will die of prostate cancer. So, it is another piece of information that might be used to help separate men into low- and high-risk groups, but it doesn't address the issues about screening and about changing the natural history of the disease. It simply says that if your PSA is higher than 0.63 ng/mL, then you have a greater chance of being diagnosed with prostate cancer some time in the future. Does that mean everyone should get a baseline test, and use that to make further decisions? I'm not sure that we can answer that at the present time. That would need a different type of study. However, we come back to the latest meta-analysis that has raised questions about the overall impact of testing and treating men with this disease. The bottom line is that this is interesting information and warrants further evaluation to see what would be the best approach, but it doesn't find all men who have aggressive cancer, and it could turn out that men who have life-threatening disease might not have been detected 30 years earlier by using this PSA cutoff. So, I'm not sure that it should be adopted at this time, but clearly it warrants further evaluation.

Thank you.

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