AUA: PSA Testing Might Not Be Necessary for Older Men
By Charles Bankhead
ORLANDO, 24 may 2008 -- At age 75, men who have PSA levels less than 3 ng/mL can safely discontinue routine prostate cancer screening because they have a low risk of developing aggressive disease, data from a large prospective cohort study suggest.
In fact, the probability of prostate cancer death and high-risk disease declined steadily in those men, Anna E. Kettermann, of Johns Hopkins, reported at the American Urological Association meeting.
In contrast, a PSA level of 3 ng/mL or greater was associated with an increased probability of developing high-risk prostate cancer.
"Men who have a PSA level below 3 ng/mL at age 75 to 80 are unlikely to develop aggressive prostate cancer during their remaining life, and for these men, PSA testing might be safely discontinued," said Kettermann.
The findings came from an analysis of data on 849 participants in the Baltimore Longitudinal Study on Aging. Investigators calculated each man's probability of developing high-risk prostate cancer in five-year increments, beginning at ages 60 to 65, stratified by PSA cutoff points of <1>3 ng/mL.
High-risk prostate cancer was defined as death from prostate cancer, a PSA value greater than 20 ng/mL, or a prostate biopsy Gleason score of 8 or higher at diagnosis.
The study population comprised 727 men who did not have prostate cancer and 122 who did -- 35 had aggressive disease and 87 were alive with cancer or had died of other causes.
The entire cohort had been followed for a median of 10 years, during which time they had a median of four repeat PSA tests.
The median baseline PSA level was 0.76 ng/mL. The median PSA level was 1.2 ng/mL in men who had high-risk prostate cancer, 1.3 ng/mL in those who had lower-risk prostate cancer, and 0.7 ng/mL in those who remained free of prostate cancer.
Overall, 18 patients died of prostate cancer, and 17 others had high-risk disease. All 35 had PSA values that exceeded 3 ng/mL at some point during follow-up.
None of the remaining 87 patients with lower-risk prostate cancer or those who remained free of prostate cancer had PSA levels that exceeded 3 ng/mL during follow-up.
"Our analysis showed that the probability of high-risk prostate cancer increased with PSA value," said Kettermann.
Primary source: Journal of UrologySource reference:Carter HB, et al "Prostate specific antigen testing among the elderly: When to stop?" J Urol 2008; 179(suppl): 600. Abstract 1751.
By Charles Bankhead
ORLANDO, 24 may 2008 -- At age 75, men who have PSA levels less than 3 ng/mL can safely discontinue routine prostate cancer screening because they have a low risk of developing aggressive disease, data from a large prospective cohort study suggest.
In fact, the probability of prostate cancer death and high-risk disease declined steadily in those men, Anna E. Kettermann, of Johns Hopkins, reported at the American Urological Association meeting.
In contrast, a PSA level of 3 ng/mL or greater was associated with an increased probability of developing high-risk prostate cancer.
"Men who have a PSA level below 3 ng/mL at age 75 to 80 are unlikely to develop aggressive prostate cancer during their remaining life, and for these men, PSA testing might be safely discontinued," said Kettermann.
The findings came from an analysis of data on 849 participants in the Baltimore Longitudinal Study on Aging. Investigators calculated each man's probability of developing high-risk prostate cancer in five-year increments, beginning at ages 60 to 65, stratified by PSA cutoff points of <1>3 ng/mL.
High-risk prostate cancer was defined as death from prostate cancer, a PSA value greater than 20 ng/mL, or a prostate biopsy Gleason score of 8 or higher at diagnosis.
The study population comprised 727 men who did not have prostate cancer and 122 who did -- 35 had aggressive disease and 87 were alive with cancer or had died of other causes.
The entire cohort had been followed for a median of 10 years, during which time they had a median of four repeat PSA tests.
The median baseline PSA level was 0.76 ng/mL. The median PSA level was 1.2 ng/mL in men who had high-risk prostate cancer, 1.3 ng/mL in those who had lower-risk prostate cancer, and 0.7 ng/mL in those who remained free of prostate cancer.
Overall, 18 patients died of prostate cancer, and 17 others had high-risk disease. All 35 had PSA values that exceeded 3 ng/mL at some point during follow-up.
None of the remaining 87 patients with lower-risk prostate cancer or those who remained free of prostate cancer had PSA levels that exceeded 3 ng/mL during follow-up.
"Our analysis showed that the probability of high-risk prostate cancer increased with PSA value," said Kettermann.
Primary source: Journal of UrologySource reference:Carter HB, et al "Prostate specific antigen testing among the elderly: When to stop?" J Urol 2008; 179(suppl): 600. Abstract 1751.
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