Longitudinal cohort studies demonstrate that PSA values ≥1 ng/mL for young patients confers an increased risk of prostate cancer diagnosis1 and potentially poor outcomes decades later. The objective of this study was to examine the clinical practice and prostate cancer detection rates among men <50 years of age with a PSA ~1.0 ng/mL.
Over the last two decades at a single institution, men <50 years of age that had a PSA between 0.5 and 2.5 ng/mL undergoing their first prostate biopsy were included (n=199) in this study. This involved 56 men with PSA ≤1 ng/mL, 38 with PSA 1-1.5 ng/mL, 57 with PSA 1.5-2.0 ng/mL, and 48 men with PSA 2.0-2.5 ng/mL. Patients were analyzed according to their specific PSA values and a multivariable logistic regression model was performed to predict covariates associated with positive biopsy results. The mean age of the cohort was 45.9 years (SD 3.9), with no differences between the PSA groups (p=0.19). Similarly, there was no difference among PSA groups with regards to prostate volume (mean 28.7 cc, SD 9.2; p=0.08), number of cores obtained (mean 10.7, SD 1.6; p=0.10), family history of prostate cancer (27.9%, p=0.30), suspicious transrectal ultrasound (TRUS) lesions (41.2%, p=0.82), prostate cancer detection rate (19.2%, p=0.07), prostate cancer worse than Epstein criteria for active surveillance (51.4%, p=0.08), or Gleason grade detected (p=0.74). A rising PSA was more likely to be the reason for prostate biopsy among men with PSA 2.0-2.5 ng/mL compared to lower PSA values (p<0.001). Among patients diagnosed with prostate cancer, over a fifth of them had at least Gleason 7 disease, with almost a third having PSA <1.5 ng/mL. On multivariable logistic regression modelling assessing predictors of a positive biopsy, higher PSA (OR 1.96, 95%CI 1.03-3.74), positive family history (OR 2.96, 95%CI 1.32-6.67), and smaller prostate volume (OR 0.93, 95%CI 0.88-0.99) were significant factors. Age and suspicious TRUS lesion were not significant.
In summary, the results presented suggest there is justification for an aggressive biopsy strategy among men <50 years of age with a PSA between 0.5 and 2.5 ng/mL, as many of them will have clinically significant disease. Despite low PSA values, family history and prostate size are important predictors of positive biopsy results.
Presented By: Hanan Goldberg, MD, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
Co-Authors: Ants Toi, Rashid Sayyid, Michael Nesbit, Neil E. Fleshner
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre Twitter: @zklaassen_md at the 72nd Canadian Urological Association Annual Meeting - June 24 - 27, 2017 - Toronto, Ontario, Canada
1. Sun L, Moul JW, Hotaling JM, et al. Prostate-specific antigen (PSA) and PSA velocity for prostate cancer detection in men aged <50 years. BJU Int 2007 Apr;99(4):753-757.