The Growing Evidence Supporting Mid-life PSA Testing

Categories: Winter 2013
In the US, early detection of prostate cancer through the use of PSA testing has resulted in an 80% decrease of men with metastases at diagnosis and a more than 45% decrease in the age-adjusted prostate cancer mortality rate, compared to the pre-PSA era prior to 1991.
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Daniel Reinhardt is a medical school student at the Northwestern University Feinberg School of Medicine. He recently joined Dr. Catalona’s research team and hopes to become a urologist and help men diagnosed with prostate cancer. Reinhardt graduated from the U.S. Naval Academy in 2004. Following graduation, he went to flight school at Naval Air Station Pensacola before joining a P-3C Orion squadron based in Hawaii. His squadron deployed twice to Iraq, where Reinhardt flew more than 100 combat missions and provided support to ground forces during Operation Iraqi Freedom in 2007 and 2008. After leaving his squadron in 2010, he became an Assistant Professor of Naval Science at the University of Notre Dame.

Yet, due to the possible overdiagnosis and overtreatment of non-life threatening cancers, the use of routine PSA testing has become controversial. However, a recent study from Memorial Sloan-Kettering Cancer Center added to the growing body of evidence supporting the value of PSA testing of men in their 40s.1

Researchers found that a PSA test in midlife is an important tool for assessing risk of developing aggressive prostate cancer and death from this disease. Their study used data from the Malmö Preventive Project, in which a group of 21,277 Swedish men aged 27–52 years provided blood samples between 1974 and 1984. The scientists compared PSA levels from these samples with the later development of prostate cancer. They determined that men in their 40s with the top 10% of PSA levels accounted for almost half of all prostate cancer deaths up to 30 years later. In other words, a man’s PSA test at the age of 45 can help predict his risk of prostate cancer into his 70s.

On the basis of their data, the researchers recommended that baseline PSA testing should be undertaken for all men in their midto-late 40s. The conclusions drawn from this study reflect those of other studies with similar findings, all of which emphasize the importance of early PSA measurement to identify men most likely to develop lifethreatening prostate cancer.

1Vickers, A., et al. Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study. BMJ. 2013; 346, f2023.

Adopted from: Reinhardt, D. & Catalona, W. J. Prostate cancer: The growing evidence supporting midlife PSA testing. Nat Rev Urol. 2013; 10(8):436-438.

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