Predicting prostate cancer many years before diagnosis: how and why?

Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
World Journal of Urology (Impact Factor: 3.42). 11/2011; 30(2):131-5. DOI: 10.1007/s00345-011-0795-8
Source: PubMed

ABSTRACT Evidence of reduced prostate cancer mortality from randomized trials in Europe supports early detection of prostate cancer with prostate-specific antigen (PSA). Yet PSA screening has generated considerable controversy: it is far from clear that the benefits outweigh risks, in terms of overdiagnosis and overtreatment. One way to shift the ratio of benefits to harm is to focus on men at highest risk, who have more to benefit than average. Neither family history nor any of the currently identified genomic markers offer sufficient risk stratification for practical use. However, there is considerable evidence that the levels of PSA in blood are strongly prognostic of the long-term risk of aggressive prostate cancer. Specifically, it is difficult to justify continuing to screen men aged 60 or older if they have a PSA less than 1 or 2 ng/ml; for men 45-60, intervals between PSA tests can be based on PSA levels, with 2-4-year retesting interval for men with PSA of 1 ng/ml or higher, and tests every 6-8 years for men with PSA <1 ng/ml. Men with the top 10% of PSAs at a young age (PSA ~1.5 ng/ml or higher below 50) are at particularly high risk and should be subject to intensive monitoring.

Download full-text


Available from: Hans Lilja, Apr 14, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article aims to review the merits of the use of prostate-specific antigen (PSA) as a screening tool in the detection of prostate cancer and the evidence presented by the US and European population-based, randomized controlled trials evaluating screening. Many studies have attempted to ascertain whether PSA screening is beneficial with respect to cancer-specific mortality. This report aims to clarify the issues specific to the PSA test, prostate cancer, sources of bias, and the future of screening. We performed an Ovid-Medline literature search for articles pertaining to the introduction of the PSA test, its use for screening for prostate cancer, confounders and biases specific to PSA and prostate cancer's natural history, and reports specific to the Prostate, Lung, Colon, and Ovarian Cancer Screening Trial (PLCO), and the European Randomized Study of Screening for Prostate Cancer (ERSPC). We reviewed these articles and present relevant data. PSA emerged as one of the most-used serum tests to screen for cancer, particularly in the US, but in Europe as well. The PLCO trial showed no benefit to screening, and the ERSPC showed a 20% relative risk reduction of cancer-specific mortality. This translated to an absolute reduction of PCa-related deaths of 0.71 per 1,000. Each trial has criticisms that may or may not have affected power and outcome, although the rate ratios comparing screening to not screening are similar. Definitive evidence for or against screening is still lacking, as interim analyses from the ERSPC and PLCO await further follow-up in the years to come.
    World Journal of Urology 11/2011; 30(2):137-42. DOI:10.1007/s00345-011-0799-4 · 3.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Das PSA-Screening konnte in der ERSPC-Studie eine Reduktion der relativen prostatakarzinomspezifischen Mortalität von bis zu 32 % zeigen. Dieser Vorteil wird jedoch weiterhin erkauft mit einem hohen Maß an Überdiagnostik und Übertherapie. Zusammen mit volkswirtschaftlichen Überlegungen ist deshalb ein generelles PSA-Screening nicht empfehlenswert. Gleichzeitig bleibt PSA der zurzeit beste Tumormarker, um dem Wunsch des Patienten nach individueller Risikoreduktion gerecht zu werden.Ein möglicher Ausweg wäre ein risikoadaptiertes PSA-Screening in einer definierten Altersgruppe: So konnte in Studien eine strenge Korrelation zwischen PSA-Höhe in frühen Lebensabschnitten und dem Risiko, Jahrzehnte später am Prostatakarzinom zu erkranken, nachgewiesen werden. Dieser Zusammenhang ermöglicht eine Risikostratifizierung anhand des individuellen ,,Baseline“-PSA, um so Hoch-Risiko-Patienten frühzeitig zu identifizieren und solche mit geringem Risiko vor Überdiagnostik und -therapie zu schützen. Die prospektiv randomisierte PROBASE-Studie untersucht dabei den optimalen Zeitpunkt zur Bestimmung eines ,,Baseline“-PSA und bewertet darüber hinaus das ideale zeitliche Protokoll eines solchen ,,intelligenten“ PSA-Screenings.
    Der Onkologe 01/2013; 19(9). DOI:10.1007/s00761-013-2493-1 · 0.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Overdiagnosis as a consequence of PSA screening for prostate cancer is a major hazard of modern medicine, claims Margaret McCartney. Jon Rees, GP with a special interest in men's health, and urologist Roger Kirby respond with their perspectives on this dilemma. Copyright © 2013 John Wiley & Sons
    03/2013; 4(2). DOI:10.1002/tre.320
Show more