Using PSA to Detect Men at High Risk for Death After Treatment

Categories: Spring 2017
Two-thirds of all prostate cancer deaths in the U.S. occur in men with localized disease who developed metastatic cancer. New research looked at PSA levels in these men after treatment to determine if there was a way to predict who was more likely to die.
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Researchers at Harvard University and Brigham & Women’s Hospital tracked PSA levels in 157 men treated with radiation and/or hormonal therapy for localized prostate cancer. The study followed the men for more than 16 years on average.

The main predictor of whether the men would die was how low their PSA level fell after radiation and/or hormonal therapy. If the PSA did not drop to 0.5 ng/mL or lower after treatment, the cancer was most likely to come back and cause early death.

Looking for patients with a PSA of 0.5 ng/mL or higher means identifying men at risk for death before PSA failure signals treatment failure. PSA failure occurs when a patient’s PSA continues to rise after treatment.

Trevor J. Royce, M.D., corresponding author of the study, said, “By identifying and enrolling these men in clinical trials immediately, the hope is to take a prostate cancer that appears to be incurable and make it curable.”

Further studies will need to examine whether intervening sooner or with more aggressive treatment in this subgroup of men will help prolong their life.

JAMA Oncol. 2017 Jan 12. doi: 10.1001/ jamaoncol.2016.5983. [Epub ahead of print]

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