Sunday, June 19, 2016

Mid-life PSA test predicts prostate cancer death

CANCER DIGEST – June 19, 2016 – A single PSA test in midlife can predict future prostate cancer death a study in the June 13, 2016 Jounal of Clinical Oncology concludes. 

Led by Mark Preston, MD, MPH, the Brigham and Women’s Hospital study started in 1982 followed more than 22,000 male physicians aged 40 to 59 who gave blood before being randomly assigned to groups, one taking aspirin and beta carotene the other given a placebo.

After following the doctors for 30 years there were 234 participants diagnosed with prostate cancer and had a PSA test at the start of the study. These were compared to 711 participants who were matched to the prostate cancer participants for age. The baseline PSA of the 71 men who died of prostate cancer were compared with 235 age-matched men without prostate cancer.

Using statistical comparisons they found that the median PSA level among the 711 in the control goup was 0.68 for those screened between age 40 and 49, 0.88 for those between 50 and 54 and 0.96 for those between 55 and 59 years old. 

When they looked at the men with prostate cancer they found that among the men whose PSA levels were in the highest 10 percent of the range for men 40-59 had a 7 to 13 times greater risk of dying of prostate cancer. 

Among those who died, 82 percent had a PSA above the median for the age group 40-49. Similarly among those who died, 71 percent had a baseline PSA above the median for the 50 to 54 age group, and 86 percent of those who died had PSAs above the median for men who had a PSA test between age 55 and 59.

"In our data, one of seven men with PSA higher than 3.0 nanograms per milliliter (ng/ml) at 55 to 59 years and one of 12 men with PSA higher than 2.1 ng/mL at 50 to 54 years died as a result of prostate cancer within 30 years," the authors wrote. 

The results support findings from 2013 Swedish study on the value of baseline PSA level. In that study found that midlife PSA levels could be used to identify a small group of men with an increased risk of aggressive prostate cancer and that careful surveillance in these men is warranted.

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