PSA Test Cut-off Could Signal Low-Risk Prostate
TUESDAY, Feb. 15 (HealthDay News) -- Men who have a low
prostate-specific antigen (PSA) score when they're first tested may
not need to be screened annually and probably don't need to undergo
a biopsy, a new study suggests.
Dutch researchers presenting the findings at the Genitourinary
Cancers Symposium in Orlando, Fla., said that few men with a PSA
below 3.0 ng/ml were likely to develop prostate cancer and die of
"PSA can identify those at low risk of prostate cancer and once you have done that, you can remove almost 50 percent of men in the age group 55 to 74 [from undergoing biopsies]," said study senior author Monique Roobol, an epidemiologist in the department of urology at Erasmus University Medical Center in Rotterdam.
For this study, about 20,000 men aged 55 to 74 in the Rotterdam
area were screened, with those having PSA scores at or above the
cut-off of 3.0 sent for biopsies and additional screenings every
four years. Eighty percent of men in the group had PSA levels below
In this group of men, the higher the PSA level at baseline, the
more likely the person was to develop prostate cancer and to die of
the disease. Only 1.8 percent of men with PSA scores below 1.0 were
diagnosed with prostate cancer, with only 0.04 percent dying of the
disease. This compares with 15.7 percent of those with scores from
2 percent to 2.9 percent developing a malignancy and 0.36 percent
dying of the disease.
"This gives us some confidence that annual PSA screening is going to soon become a thing of the past," said Dr. Nicholas J. Vogelzang, chair of the Developmental Therapeutics Committee of US Oncology, who moderated the teleconference. "A low PSA, particularly those in men who have less than 1.0, and probably those less than 2.0, certainly could be considered for substantially longer intervals of PSA screening... Personalization of PSA screening is clearly underway."
A second study also being presented at the symposium found that
a drug already used to treat enlarged prostate gland may delay the
progression of low-risk, early prostate cancer among men who choose
a wait-and-see approach to treatment.
In comparison to men with low-risk, early-stage prostate cancer
who took a placebo, "men randomized to receive Avodart saw their
chance of progression significantly reduced, by approximately 40
percent," said study author Dr. Neil Fleshner, head of urology at
the University Health Network and Love Chair in Prostate Cancer
Prevention at Princess Margaret Hospital, both in Toronto. "Men
with low-risk prostate cancer who want to have a period of
observation should consider using this drug."
But the maker of Avodart (dutasteride), GlaxoSmithKline, is
unlikely to apply for new approval to market the drug for what is
essentially prevention, meaning it would be used off-label in this
context, he added.
A final study of almost 4,000 patients found that surgeons
needed to perform 1,600 procedures known as robotic-assisted
laparoscopic radical prostatectomies (RALP) to become adept at the
procedure. In comparison with typical laparoscopic surgery, RALP
offers surgeons three-dimensional vision and such improvements as
better magnification and hand tremor filtering.
"We recommend that this operation should not be done by all urologists in small community hospitals but should be focused and concentrated on high volume centers of excellence... in order to achieve best possible results for patients," said study author Dr. Prasanna Sooriakumaran, a visiting fellow in urology at the Weill Cornell Medical College in New York.
"The procedure is not as easy as manufacturers make it out to be, and enthusiasm in the U.S. needs to be tempered in terms of which hospitals should be buying the equipment and which surgeons should be doing these sorts of operations," he added.
One caution, though, is that the study only looked at three
surgeons performing RALP.
The National Cancer Institute has more on
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