BERKELEY, CA (UroToday.com) - The National Comprehensive Cancer Network recommendation for PSA screening is an initial PSA baseline at age 40 years, and if the value is below the age-related median of 0.7ng/ml, then the next screening PSA is not needed until age 45. If it is above 0.7ng/ml, then annual screening is recommended. Dr. Stacy Loeb and colleagues to include Dr. Catalona investigated this and in the May 2007 issue of the Journal of Urology report that men age 40-49 with a PSA less than the age specific median have a low risk of prostate cancer (CaP).

A total of 1,083 men age 40-49 with a family history of CaP or of black ancestry were identified in Dr. Catalona's CaP screening database. Mean age was 45 years and 50% were African-American. A positive family history of CaP was present in 57%. The median PSA for these men was 0.7ng/ml; 54% had a PSA below this value and 46% had a PSA above it. More men with a positive family history had a value above the median and a greater proportion of African-American men had a PSA below the median.

The likelihood of reaching the PSA threshold for a prostate biopsy was highly dependent on the baseline PSA level. PSA velocity was similar between those with a baseline PSA above and below the median, although 97% with a baseline below the median had a PSAV less than 0.75ng/ml, compared to 91% of participants with a PSA above the median. A total of 48 (4%) of these men underwent a prostate biopsy; 44 had a level above 0.7ng/ml and 4 had a baseline below 0.7ng/ml. Seven of these men had an abnormal DRE. CaP was detected in 26 men of whom 15 were African-American and 16 had a positive family history. Median age at diagnosis was 47 years and 25 of the 26 men diagnosed had a PSA above the age specific median at initial screening and 1 had a level below it. In the 25 men diagnosed with CaP and an initial PSA level above the median, the median PSA at diagnosis was 3.9ng/ml. The mean biopsy Gleason score was 6 and 24 underwent radical prostatectomy and 18 (78%) had organ confined disease with negative surgical margins. Biochemical progression had occurred in 6 men (24%).

In men age 40-49 with a baseline PSA level below the age-specific median of 0.7ng/ml, the annual percent change in PSA and PSAV were low, thus supporting the recommendations of the National Comprehensive Cancer Network.

Loeb S, Nadler RB, Roehl KA, Antenor JAV, Catalona WJ

J Urol 2007; 177(5):1745-48.

UroToday.com Prostate Cancer Section

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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