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
“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:
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
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.