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Change in PSA a predictor of prostate cancer diagnosis

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PSA provocation may be an important strategy in the identification of men at risk for prostate cancer, according to researchers from Dallas.

Forty men with PSA between 2.5 ng/mL and 4 ng/mL were given one intramuscular injection of 400 mg testosterone cypionate at the beginning of the study. The researchers measured PSA and early morning serum testosterone at baseline, at 48 hours and at weeks one, two and four.

Eighteen of the men (45%) were diagnosed with prostate cancer. Changes in PSA following androgen stimulation were found to be significantly associated with the percent of tissue involved with cancer, according to the researchers.

There is precedence for this kind of approach in diagnosing cancer with a tumor called medullary thyroid cancer that makes calcitonin. Stimulatory tests with calcium and pentagastrin have been used to diagnose that condition. In fact, the premalignant state of medullary thyroid cancer, called C-cell hyperplasia, can also be diagnosed by giving those stimulatory tests. Thus, the idea is intriguing.

The challenge with this study is it is considerably smaller than you would like to see, but it is a provocative idea. The negative comments that were made by the commentators are appropriate, although from my perspective, they do not detract from the interesting aspects of this trial. There is also the issue, however, that it was judged that 400 mg of testosterone would be safe; we do not really have any evidence that that is true. That is why if this idea was pursued, and became a way to recognize prostate cancer more accurately, particularly the cancers that are likely to be more dangerous, it is even possible that the higher-grade cancers might respond differently than the lower- grade cancers. This general area has a lot of theoretical appeal, but would have to be done carefully, and it is not a certainty that giving a slug of testosterone would not be harmful.

– Donald L. Trump, MD, FACP

HemOnc Today Editorial Board member

For more information:

J Urol. 2008;doi:10.1016/j.juro.2008.01.142.