Lethal Prostate Cancer

A case-control study found that a midlife PSA above the median strongly predicted future lethal prostate cancer. The authors suggested that risk-stratified screening on the basis of midlife PSA should be considered for men ages 45 to 59 years.

The study included 234 men with prostate cancer, 71 of whom developed lethal prostate cancer, and 711 age-matched controls. The men were participants in the Physicians’ Health Study.

Median PSA among controls was 0.68, 0.88, and 0.96 ng/mL for men age 40 to 49, 50 to 54, and 55 to 59 years, respectively. A total of 82%, 71%, and 86% of lethal cases of prostate cancer occurred in men with PSA above the median at ages 40 to 49, 50 to 54, and 55 to 59 years, respectively.