Elevated PSA at Midlife Predicts Aggressive Prostate Cancer in Blacks
The totality of evidence from this study and previous work provides strong support for use of midlife PSA level to determine a personalized screening strategy.
Reserchers studied PCa development in black men aged 40 to 64 years from the Southern Community Cohort Study. The team identified 197 PCa cases, including 91 cases of aggressive disease, defined as Gleason score 7 or higher, American Joint Committee on Cancer (AJCC) stage III or IV, or PCa-specific death. Each case was matched to up to 3 controls, for a total of 569 men in the control group. Median time from blood draw to diagnosis was 4.4 years among all cases and 5 years among aggressive cases (maximum 10.25 years).
Compared with PSA values at or below the median, a PSA value above the 90th percentile was associated with 83.6-fold and 174-fold increased odds of total and aggressive PCa, respectively, for men aged 40 to 54 years and 71.7-fold and 51.8-fold increased odds of total and aggressive PCa, respectively, for those aged 55 to 64 years.
Notably, the investigators said they observed increased risk with PSA levels of 1.1 to 1.7 ng/mL at ages 40 to 54 years, well within the "normal" range "and low enough not to trigger follow-up in usual clinical practice.
These findings do not imply that prostate biopsy or definitive treatment is immediately required in younger men with higher PSA levels at baseline, as this could lead to over-diagnosis, but that they undergo more intensive PSA screening to enable earlier identification of cancer and potential cure while still possible.
Preston MA, Gerke T, Carlsson SV, et al. Baseline prostate-specific antigen level in midlife and aggressive prostate cancer in black men. Eur Urol. DOI:10.1016/j.eururo.2018.08.032