PSA Level at Age 60 Predicts Risk of Prostate Cancer Death 25 Years Later

A man’s level of prostate specific antigen (PSA) at age 60 predicts his lifetime risk of metastasis and death from prostate cancer, a study of Swedish men indicates.

 

The findings, published online September 14 in BMJ, could be useful in determining which men should be screened for prostate cancer after the age of 60 and which may not benefit substantially from continued screening.

 

“We know that screening detects many prostate cancers that are not harmful, leading to anxiety and unnecessary treatment. It is our ability to determine the risk of the really aggressive cancers that make this approach of such great potential value,” said study investigator Andrew J. Vickers, PhD.

 

 He and his associates from Memorial Sloan-Kettering Cancer Center, New York, and Lund University, Sweden, studied blood samples collected in 1981 and 1982 from 1167 men born in 1921 as part of the Malmö Preventive Project. The men were followed to age 85 or death. A total of 126 men were diagnosed with prostate cancer. There were 43 cases of metastasis and 35 deaths from prostate cancer. Ninety percent of deaths occurred in men in the top 25% of PSA concentrations (>2 ng/ml) at age 60.

 

In contrast, men whose PSA level at age 60 was ≤1 ng had just a 0.5% risk of metastasis and a 0.2% risk of death from prostate cancer.

 

The researchers advise that men with a PSA concentration >2 ng/ml at age 60 should continued to be screened regularly. Those with levels ≤1 ng may not need to be screened in the future. These men may have prostate cancer but it is not likely to cause symptoms or become life-threatening, they say.