Finding

On Cancer: A Single Early PSA Test Found to Predict Long-Term Risk of Aggressive Prostate Cancer

By Allyson Collins, MS, Science Writer/Editor  |  Wednesday, April 17, 2013

Some doctors and researchers have recently questioned the benefits of prostate-specific antigen (PSA) blood testing for men, in light of the fact that it may detect slow-growing prostate cancers and result in unnecessary treatment and side effects. In fact, the US Preventive Services Task Force released recommendations in June 2012 stating that men should no longer undergo the test.

However, Memorial Sloan Kettering experts maintain that PSA testing saves lives, and have been working to determine smarter ways to screen men to ensure that those at a higher risk for aggressive prostate cancers can be diagnosed and treated, while those at a lower risk can avoid unnecessary treatment.

Now, a study published April 16 issue in the British Medical Journal reveals that certain men may need only three PSA tests in their lifetime.

“Our findings have led to recommendations that aim to ensure men get the maximum benefit from PSA screening,” explains statistician Andrew Vickers, who worked with a team of researchers at Memorial Sloan Kettering, the University of Washington, and Skåne University Hospital, in Sweden.

PSA Screening Recommendations

Investigators analyzed blood samples from a group of more than 21,000 men living in Malmö, Sweden, who participated in a large research study known as the Malmö Preventive Project. Though these men did not undergo regular PSA testing as part of their care, some were diagnosed and treated for prostate cancer.

Dr. Vickers and colleagues were able to test PSA levels in the blood stored from study participants and review the medical treatment records of these men to determine the aggressiveness of their cancers.

After analyzing this information, researchers concluded that most men should have their first PSA test around age 45, unless they have a strong family history of prostate cancer. Age 40 may be too early, and age 50 may be too late to identify a man’s risk of developing an aggressive cancer, Dr. Vickers explains.

This initial test can be used to place men on one of two screening paths:

  • Men with a PSA level of 1.0 nanograms/milliliter or higher at age 45 are at an above average risk of developing life-threatening prostate cancer. These men should be regularly screened for changes in PSA level until around age 70, with repeat PSA testing.
  • Men with a PSA level at or below 1.0 nanograms/milliliter should have two additional PSA tests, one in their early 50s and another at 60 to ensure that their PSA levels remain low. Testing is not necessary after age 60 because any cancer that develops will likely be slow growing and not life threatening.

“The big take-home message is that a single PSA test at age 45 can be used to predict a man’s long-term risk of developing an aggressive prostate cancer,” Dr. Vickers says.

Comments

i have prostate cancer and am currently under active survellance (3+years)my experience appears to back up Dr. Vicker's findings.My PSA,at age 56 was under 1,rose to 1.4 and then to 1.9 over three years.My doctor recommended seeing a Urologist who suggested a biopsy and a small non-aggressive cancer was found.i chose active surveillance after much personal research as well as support of Dr.Eastham at Sloan.

I think this is the right approach that will help detect patients that need treatment as well as keep the cost of screening low.

how does one know if an elevated PSA is due to cancer or BPH

Unfortunately we are not able to provide personal medical advice on our blog. If you'd like to make an appointment to speak with a Memorial Sloan-Kettering doctor, please call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

I've had high psa readings since I was 30 years of age with an enlarged prostate.
My readings ranged from 3 to as high as 27 over a period of 25+ years. I had gone through more than 13 biopsies with only an occasional pin reading.
I finally had a turp due the retention of urine attacking my kidneys. My nominal psa readings after the operation is considered my "normal" is 6.
That is what it has remained at for the past 6 years. I go for a check up once a year at this point.

All men at the age of 45 should have a psa done because it help when they can detect it early on in life.Everybody should get involve to help encourage all fathers and sons to go and get their psa reading done for the prevention of prostate cancer.

For a man with a family history of prostate cancer, what age do you recommend the first PSA test?

Nathan, we are not able to answer individual medical questions on our blog. We recommend that you speak with your doctor about this. Thank you for your comment.

The reason I asked was because you give a very specific age to get the first PSA test. I was hoping your research gave some indication as to what is a better earlier age to get that first PSA test for those of us with a family history of prostate cancer. I did not intend my question to be an "individual medical question"

Nathan, you can view our screening guidelines for prostate cancer here: http://www.mskcc.org/cancer-care/screening-guidelines/screening-guidelines-prostate Thank you for your comment.

When a biopsy is conducted and "precancerous cells" are found. What does that mean or imply?

Gary, unfortunately we are not able to answer personal medical questions
on our blog. We recommend you speak with your doctor about what was meant
by "precancerous cells." If you'd like to speak with a physician at
Memorial Sloan-Kettering, please call 800-525-2225. Thank you for your
comment.

Thank you Dr Vickers for such a clear and jargon free 4 minute video introduction to your study about the value of a single PSA test and a conclusion that many men may only ever need three PSA tests throughout their lifetime. I have added a link to your study to the red sock prostate cancer awareness website here in the UK where I am sure it will be of great interest to many of my followers.

I have prostate cancer and have elected to have surgery after all test were negative on any spread of it. do you think this is a wise choice? I was told it is fairly aggressive and should not wait to long.

Bobby, unfortunately we are not able to provide personal medical advice on our blog. If you'd like to make an appointment to speak with a Memorial Sloan-Kettering doctor, please call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

My first PSA numbers started out at 6 and after several blood tests over a two year period have gone down to 1.4. How does the Gleason Score factor into prostate cancer? I have also had three biopsies.

Mickey, the Gleason score is assigned by the pathologist who makes the diagnosis of prostate cancer. It is one of the factors that predicts the risk of the prostate cancer. In general the score ranges from 6 to 10 with 6 being considered favorable risk. If you would like to speak with a doctor at Memorial Sloan-Kettering, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

Interesting, with so much conflicting information in the public about the benefits, or lack thereof, of the PSA exam, it would be good to one day know definitely if the PSA is of significant benefit or not.

As a result of my PSA numbers increasing from 3 to 6 over the course of the past year and a subsequent biopsy that had one hit out of 12 samples, resulting in a Gleason score of 7, I'm scheduled for surgery next week. Under the circumstances, I view the USPSTF opinion discouraging routine PSA with disbelief and anger. I'm asymptomatic and my digitial exams reveal nothing abnormal, which begs the question how - and when - would my condition have been discovered without a simple PSA test? Considering the dangerous or possibly fatal alternative, an annual pin prick on the arm is not the big deal anti-testing statisticians make it out to be.

Six months ago I had two prostate biopsy, in which came back negative for cancer. They noticed that I had focal asap, but no cancer. At that time my psa was 7.31. Six months later, I take a psa test and it comes back 14.40. I did not have any sex, or ride a bike for at 3 days. Can you tell me what is goin on. How can something like this double so fast.

Anthony, we are unable to answer specific medical questions on our blog. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

I havr had 3 psa test
Over a 6 month period
the first came back 18 the second 21 and the third 6 months later came back 30
I had one biopsy and it was negative after the 21 test result

What can this mean and also does haveing frequent sex and exercising increase psa levels? thank-you
Pkease answer soon

Lee, we are not able to answer personal medical questions on our blog. We recommend that you check with your doctor about whether sexual activity and exercise may be affecting your PSA tests. You might also want to contact the National Cancer Institute's Cancer Information Service at 800-4CANCER or http://www.cancer.gov/aboutnci/cis to get more information on this topic. Thanks for your comment.
.

Can an enlarged prostate effect sexual functioning and if so what
Does a high psa definitely mean cancer
Can a high psa be present with an enlarged prostate and not mean cancer
Thanks
Lee

Lee, we are not able to answer personal medical questions on our blog. We recommend that you check with your doctor about the possible implications of an enlarged prostate and PSA levels. You might also want to contact the National Cancer Institute's Cancer Information Service at 800-4CANCER or http://www.cancer.gov/aboutnci/cis to get more information on this topic. Thanks for your comment.

I have read that ultrasound biopsies have false negatives 30% of the time. If this is the case, why not do an MRI first and do targeted biopsies?

Martin, we are unable to answer specific medical questions on our blog.
For questions about prostate cancer treatment, you can call the National Cancer Institute’s Cancer Information Service at 800-4CANCER (800-422-6237).If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

help me

Hasti, if you would like to speak to someone at Memorial Sloan-Kettering about making an appointment, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information.

I am 52 and was first diagnosed with a high PSA of 52 in April than 37 one month later than back to 49 in the last 2 tests in the last weeks .After a referral to a Specialist and a biopsy I was diagnosed with a Gleason 7 with a 25% cancer in the apex core..My Specialist feels that the cancer is probably more aggressive than indicated in the pathology report and will to do urgent radical surgery in the next few weeks...My concern is because of the consistent very high PSA the cancer may have well spread outside the capsule..Is it likely my surgeon/Specialist will test for this while doing the surgery before proceeding? Bone scans were negative but my concern is for the lymph nodes and the cancer location ..any advice would be appreciated as I would prefer not to have the surgery if it has spread...The high PSA really concerns me.

Patrick, we are not able to answer personal medical questions on our blog. If you'd like to make an appointment to speak with a Memorial Sloan-Kettering physician, please call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information.

My dad had prostate cancer 15 years ago. He had radiation seed and additional radiation. Now his PSA levels come back high, he had a nuclear scan and it said he had prostate cancer. He had biopsy of his prostate and shows negative. Not sure of next step, is their another test. Can biopsy come back negative and still have prostate cancer?

Julianne, we are unable to answer specific medical questions on our blog. For questions about prostate cancer treatment, you can call the National Cancer Institute’s Cancer Information Service at 800-4CANCER (800-422-6237).If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

My husband, his oldest brother, his father, and his father's brother all were diagnosed with Prostate cancer. The oldest brother was diagnosed in his late 50's and my husband was diagnosed in his herly 60's, before age 65. Additionally, there is a strong family history of cancer on both sides of the family with my husband being diagnosed with both Nodular sclerosing Hodgkin's Lymphoma and Prostate Cancer; my father diagnosed with glioblastoma; and my husbands father diagnosed with MM and prostate cancer. What would be the best age for my 3 sons to have their first PSA test? Their ages are 29, 31 and 33.

Maureen, unfortunately we are not able to provide medical advice on our blog. We recommend that you speak with a physician or genetic counselor about this. If you'd like to speak to someone on Memorial Sloan Kettering's Clinical Genetics Service about your family history and what measures your sons should be taking, you can call 646-888-4050 during regular business hours or go to http://www.mskcc.org/cancer-care/hereditary-genetics for more information. Thank you for your comment.

When are the medical profession and government in the uk going to come up with a cohesive policy on testing? Some doctors say the test is pointless while others swear by it.In my case i was aware of the dangers as my father had prostate cancer.I had to ask 3 times for a test and was not asked about symptoms and was told all men have some cancer and there was nothing to worry about.One doctor i spoke to said we are all going to die and he didn`t want to know his psa reading.If this is the attitude of the doctor what chance do men have of preventing prostate cancer?i have had treatment and am doing well.

Just to add if i had not pushed for a test i would now have incurable prostate cancer as i had quite an aggressive cancer, a gleason7 Something the doctors never explained.They say they have no way of knowing which are the agressive cancers and which are slow growing.A biopsie ,not very pleasant ,will indicate the gleason score which shows how agressive it is.
Men in the uk did you know that you are entitled to a psa test (a simple blood test) by law if you are over fifty?No? neither did i! get informed about this deadly disease and save your life!

Several questions in this forum were given the generic we do not answer personal or specific medical questions but an offer of an appointment. These questions were not prognosis seeking, nor specific such as PSa elevation from Bph or cancer. Your forum could provide anxiety relieving info or a more focused pusuit for treatment instead of the institutionalized "we can't or won't" attitude. If the person running the forum isn't qualified to answer these questions that should be disclosed. I would like to see an opening of minds and reception to these questions and willingness to provided information to patients seeking it, yet routinely disclosed to insurance inquiries whether patients authorize it or not. HM

Harry, thank you for your thoughtful comments and suggestions. Our blog editors are committed to responding to comments and questions on our blog. We respond to all comments personally, often after research to provide a reader with the information he or she is looking for.

Our physicians are sometimes able to provide additional general information through our blog, but in many cases they or we determine that these questions are best left to a medical professional who is familiar with the patient's entire history. This is why we frequently advise people to either speak to their own doctors or to make an appointment to speak with one of ours.

Thanks for seemingly adressing my concerns I only wish other sectors of our society were as considerate as yours. I do think questions presented annonymously; general questions do not harm but instead lower barriers from practioner to patient to partner in their health insteasd of treating patient as though he/ she were a subordinate. I recognize my cynicism that has become a sort of conditioned response. My apologies

I am 59 years old and live in Canada,my psa level is 4.3 and not cancerous as my doctor told me,I am going back in 2 weeks for another exam is this a concern.Your thoughts please

Dear Marc, unfortunately we cannot answer personal medical questions like this on our blog. We encourage you to discuss your questions and concerns with your doctor.

You may learn more about the pros and cons of PSA screening by viewing the related videos linked on this blog post: http://www.mskcc.org/blog/single-early-psa-test-found-predict-long-term-risk-aggressive-prostate

Thank you for your comment.

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