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Higher baseline PSA may be linked to increased prostate cancer risk

ASCO 2011 Genitourinary Cancers Symposium

ORLANDO — The risk for prostate cancer and aggressive prostate cancer increased as PSA scores increased among a cohort of men with a PSA scores less than 3 ng/mL, according to findings from the European Randomized Study of Screening for Prostate Cancer.

Monique J. Roobol, PhD, of the Department of Urology at Erasmus Medical College in Rotterdam, the Netherlands, said that the analysis involved 15,758 eligible men aged 55 to 74 years with a PSA risk score less than 3 ng/mL. Men were grouped according to PSA scores <0.9, 1.0-1.9 and 2.0-2.9 ng/mL.

“Distribution of incidence, aggressiveness and disease-specific mortality of prostate cancer per PSA range were measured during a median follow-up time of 11 years,” Roobol said in a press screening in advance of the 2011 Genitourinary Cancers Symposium. “Cases were identified at four yearly re-screens.”

The first screening took place from 1993 to 1999, and the final follow-up occurred in 2008, according to Roobol.

“The risk of prostate cancer increases with increases in baseline PSA score,” she said. “We see a fourfold increase with a PSA score below one compared to 1.0 to 1.9, and a tenfold increase comparing a score below one compared with 2.0 to 2.9.”

The risk of aggressive prostate cancer was 2.7 times higher in the 1.0 to 1.9 group compared with the <0.9 group, and 6.2 times higher in the 2.0 to 2.9 group compared with the <0.9 group, according to Roobol.

She also noted that the risk for disease-specific mortality was 7.6 times higher in the highest PSA group compared with the lowest group.

“These results contribute to individual risk stratification and management of men in PSA-based screening programs,” Roobol said. “For example, favorable outcomes in men with initial PSA values less than one supports prolongation of the screening interval.”

Roobol also noted that these results may justify altering the PSA threshold to ≥3.0 ng/ml.

Disclosure: Dr. Roobol reports holding a consultant or advisory role with Bechman Coulter, GlaxoSmithKline and Gen-Probe.

For more information:

PERSPECTIVE

Mark Stein, MD
Mark Stein

In patients with a presenting PSA of less than 2.0 the median time to development of cancer was approximately 8 years, suggesting that patients with lower PSA values at the time of the first screen may be followed at longer intervals.

Overall, this study suggests that lower the biopsy threshold below a PSA of 3 ng/mL would result in unnecessary testing for the large majority of men. At the same time the need for better screening methods to identify the small group of men at risk of developing aggressive prostate cancer, despite a low PSA remains unmet.

- Mark Stein, MD

HemOnc Today Editorial Board Member

Disclosure: Dr. Stein reports no relevant financial disclosures.

Twitter Follow HemOncToday.com on Twitter.

ASCO 2011 Genitourinary Cancers Symposium

ORLANDO — The risk for prostate cancer and aggressive prostate cancer increased as PSA scores increased among a cohort of men with a PSA scores less than 3 ng/mL, according to findings from the European Randomized Study of Screening for Prostate Cancer.

Monique J. Roobol, PhD, of the Department of Urology at Erasmus Medical College in Rotterdam, the Netherlands, said that the analysis involved 15,758 eligible men aged 55 to 74 years with a PSA risk score less than 3 ng/mL. Men were grouped according to PSA scores <0.9, 1.0-1.9 and 2.0-2.9 ng/mL.

“Distribution of incidence, aggressiveness and disease-specific mortality of prostate cancer per PSA range were measured during a median follow-up time of 11 years,” Roobol said in a press screening in advance of the 2011 Genitourinary Cancers Symposium. “Cases were identified at four yearly re-screens.”

The first screening took place from 1993 to 1999, and the final follow-up occurred in 2008, according to Roobol.

“The risk of prostate cancer increases with increases in baseline PSA score,” she said. “We see a fourfold increase with a PSA score below one compared to 1.0 to 1.9, and a tenfold increase comparing a score below one compared with 2.0 to 2.9.”

The risk of aggressive prostate cancer was 2.7 times higher in the 1.0 to 1.9 group compared with the <0.9 group, and 6.2 times higher in the 2.0 to 2.9 group compared with the <0.9 group, according to Roobol.

She also noted that the risk for disease-specific mortality was 7.6 times higher in the highest PSA group compared with the lowest group.

“These results contribute to individual risk stratification and management of men in PSA-based screening programs,” Roobol said. “For example, favorable outcomes in men with initial PSA values less than one supports prolongation of the screening interval.”

Roobol also noted that these results may justify altering the PSA threshold to ≥3.0 ng/ml.

Disclosure: Dr. Roobol reports holding a consultant or advisory role with Bechman Coulter, GlaxoSmithKline and Gen-Probe.

For more information:

PERSPECTIVE

Mark Stein, MD
Mark Stein

In patients with a presenting PSA of less than 2.0 the median time to development of cancer was approximately 8 years, suggesting that patients with lower PSA values at the time of the first screen may be followed at longer intervals.

Overall, this study suggests that lower the biopsy threshold below a PSA of 3 ng/mL would result in unnecessary testing for the large majority of men. At the same time the need for better screening methods to identify the small group of men at risk of developing aggressive prostate cancer, despite a low PSA remains unmet.

- Mark Stein, MD

HemOnc Today Editorial Board Member

Disclosure: Dr. Stein reports no relevant financial disclosures.

Twitter Follow HemOncToday.com on Twitter.

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