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Less frequent screening possible in men with low PSA

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American Urological Association Annual Meeting

New data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial indicate that less than 1% of men with a low initial PSA value increased to a PSA >4 ng/mL — the PSA trigger value for biopsy — within five years. Less frequent screening for these men could reduce the number of PSA tests by 70% without severely affecting the number of men diagnosed early.

“We looked at cancers that we diagnosed in that 1% and the majority were low-grade, nonadvanced cancers,” E. David Crawford, MD, professor of surgery/radiation oncology & urology, head in the section of urologic oncology at Anschutz Cancer Center and senior associate director of the Comprehensive Cancer Center at University of Colorado Health Sciences Center in Denver, told HemOnc Today. “If you apply this across the population you can reduce PSA screening by as much as 70% and potentially save $1 billion per year in the health care system.”

The PLCO study included 76,693 men aged of 55 to 74 years. Participants were randomly assigned to screening or usual care. The researchers measured PSA at six annual screening rounds and performed digital rectal exam at the first four exams.

Crawford and colleagues examined changes in PSA over five years in 29,582 participants in the screening arm with baseline PSA ≤4 ng/mL and who had at least one subsequent PSA exam. They determined the proportion of men who converted from PSA ≤4 ng/mL to PSA >4 ng/mL at years one through five; those who did were followed for at least seven years for cancer diagnosis.

Eleven percent of men had PSA levels that increased from ≤4 ng/mL to >4 ng/mL through five screening rounds. More men with higher initial PSA levels converted to PSA levels >4 ng/mL during the study: 1.32% of participants with baseline PSA <1 ng/mL and 66.21% of participants with baseline PSA 3 ng/mL to 4 ng/mL.

During seven years of follow-up, the proportion of prostate cancer diagnoses increased with higher baseline PSA levels; 0.60% for men with baseline PSA <1 ng/mL and 23.29% for men with baseline PSA between 3 ng/mL and 4 ng/mL.

“At this time, the data are not supportive of early detection, but it could become positive in the future,” Crawford said. – by Stacey L. Adams

For more information:

• Crawford ED. #2123. Presented at: American Urologic Association Annual Meeting; April 25-30, 2009; Chicago.