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


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.


Commenting is disabled for this blog post.

Dear FB, we sent your inquiry to one of our urologic surgeons, Dr. Behfar Ehdaie, and he responded:

“There has been no evidence that prostate cancer cells spread with needle biopsies. Prostate cancer is not like a virus or bacteria in which an organism penetrates a new area and grows. Instead, prostate cancer is cellular/molecular changes that result in uninhibited growth of cells. Prostate biopsies do not trigger these molecular changes. Furthermore, we have proof that prostate biopsies are safe by evaluating the thousands of men on active surveillance for prostate cancer across the world in which the progression to metastatic disease is exceptionally rare and NO cases of prostate cancer in the rectum have been reported in these series. We use a sterile needle and clean procedure to minimize infectious complications which is the highest risk of prostate biopsy.”

We hope this is helpful. Thank you for your question.

Is it common ( or possible ) to have PSA test level fluctuate towards a better result in lets say a week?

Lets use the example of PSA of 17 in a week drop to a 12, which is a 25% decrease? What if the levels continue to drop at or near that rate.

Maybe eliminating high intensity exercise, and no sexual activity, and other things?

Are there other test other than biopsy practiced in the U.S. or otherwise?

Is it common ( or possible ) to have PSA test level fluctuate towards a better result in lets say a week?

Lets use the example of PSA of 17 in a week drop to a 12, which is a 25% decrease? What if the levels continue to drop at or near that rate.

Maybe eliminating high intensity exercise, and no sexual activity, and other things?

Are there other test other than biopsy practiced in the U.S. or otherwise?

We sent your questions to Dr. Bahfar Ehdaie, an expert in prostate cancer, who responded, “PSA can fluctuate significantly. We often see fluctuations of up to 50%. In most cases a rise is followed by a change in the opposite direction of equal or greater value. Many factors contribute to these fluctuations. We do recommend abstaining from sexual intercourse 48 hours prior to a PSA serum test. Currently, the clinical guidelines do not support any test besides a biopsy to diagnose prostate cancer.”

Thank you for your comment.

my brother was just diagnosed with stage 4 prostate cancer, it spread all over his body except his bones, he's on hormone shot every 3 mths casodex and pain meds, he still walking working and riding his bike like there is nothing wrong with him.. he faxed over his medical records to sloan but has not heard anything back. Is he still a canadate to be seen at your facility

I don't understand why physicians don't recommend a MRI of the prostate BEFORE the biopsy. An MRI can tell where the cancer is located so that directed biopsies can be taken rather than poke and pray, increasing the risk of missing a cancerous spot on the gland.

Dear Lara, we send your inquiry to urologic surgeon Dr. Vincent Laudone, and he responded:

“Currently there is no test that can reliably replace a biopsy. Prostate MRIs have improved significantly in recent years and are now probably the best indicator of what a biopsy is likely to show in a man with an elevated PSA. If the MRI is completely normal the likelihood that a prostate biopsy will show a significant cancer is low. If the MRI does show a lesion this gives us more confidence in recommending a biopsy and, most importantly, gives us a target to biopsy. New technology allows us to use the MRI images simultaneously with the ultrasound to perform the biopsy. This is called MRI/ultrasound fusion guided biopsy. If cancer is found on biopsy, the MRI provides information regarding the local extent of the disease, identifying spread outside of the prostate, in lymph nodes, or in the bones of the pelvis. For all of the above reasons, MRIs are now increasingly recommended prior to biopsy. However, this is an evolving and dynamic technology in which the data regarding accuracy and usefulness of the MRI is still being accumulated. As a result, many insurance carriers do not routinely cover MRIs done prior to biopsy - although this is slowly changing.”

We hope this information is helpful. Thank you for reaching out to us.



Dear Corrie, the prostate-specific antigen (PSA) test measures the level of a protein made by cells in the prostate gland in a man’s blood. It’s normal to have a low level of PSA. PSA levels rise when there’s a problem with the prostate. To learn more about PSA, risk factors for prostate cancer, and our screening recommendations, please visit https://www.mskcc.org/cancer-care/types/prostate/screening/psa-test. Thank you for reaching out to us.

Last year my PSA was .9. One year later it was 2.3. 6 weeks later it was 1.7. After the 1.7, DRE was normal. No symptoms or family history. What does this information suggest. Is there a low likelihood of advanced PC?

Dear Steve, unfortunately we are not able to answer medical questions on our blog. We recommend you discuss your concerns with your doctor. Thank you for your comment, and best wishes to you.

Although I have always had great respect for doctors( my brother is a member of that illustrous tribe) I suspect this psa conundrum is as much boondoogle as it is good science. While physicians are no doubt' brighter than most of us, they are not necessarily more virtuous or moral. I would be willing to wager a fair number of them are interested in keeping the practice of urology a cottage industry and that the old rejoinder to " do no harm" has been replaced by a newer one: "If my recommended treatment causes no irreparable harm why not make a few bucks out of it." How else explain the pletheora of views so disparate as to be mutually exclusive. Like:
PSA, a function of hyperplasia or cancer itself? Or, no need for psa testing beyond 60 if at 40 years of age a man had a psa less than 1. Or, a personal favorite.. the use of the discredited psa ( now free or bound ... take your pick... now used as one of the unholy four in creating the 4k algorithm which seems to have struck the medical fraternity's recent fancy. Or perhaps, the most damning of all... that there is no appreciable difference in five year and ten year longevity whether a localized tumor is treated or watchfully waited.
I wish someone from the medical fraternity would answer this one question about the new darling 4k test. What percent of those unfortunate men judged to be in dire danger of harboring an aggressive cancer (or waiting for its up to twenty five year arrival!) have been found to actually have such a thing?

Seldom have so many known so little about so much.

What is your opinion on the 4KSore Prostate Cancer Test? I didn't see it mentioned in any of the material I read on your page. Do you think there is a benefit to the test or is it just a new way to read old tests?

Dear Matteo, MSK does not perform this test in our hospital lab, but we often refer patients to outside labs that can collect and process specimens for the test and send us the results.Those results may be included when making treatment decisions. Thank you for your comment.