New Way to Use PSA May Predict Risk of Metastatic Prostate Cancer or Prostate Cancer-Related Death

A large study of more than 12,000 Swedish men showed that first-time prostate-specific antigen (PSA) levels for men age 44 to 50 predicts the chance of developing metastatic prostate cancer (cancer that has spread to other parts of the body) or dying of the disease up to 30 years later. PSA is found in higher-than-normal levels in men with various conditions of the prostate, including prostate cancer and noncancerous conditions.

Researchers found that 44% of the men who died from prostate cancer had the highest PSA levels when they were initially tested between the ages of 44 and 55. Accordingly, men with lower levels of PSA for their age group had a much lower risk of developing metastatic prostate cancer or dying from prostate cancer.

In this study, researchers defined a low PSA level as one that was lower than the mid-point for the levels from all men in a specific age group. They found that men with these lower PSA levels had a much lower risk of dying or developing metastatic prostate cancer: 28% of the metastatic cancers or deaths were in men between ages 44 and 50 who had a low PSA level, 18% occurred in men ages 51 to 55 with a low PSA level, and less than 1% occurred in men with low PSA levels at age 60.

The risk for men age 44 to 55 may seem high; however, researchers noted that the short-term risk of metastatic prostate cancer or dying from prostate cancer is very low. Because this study shows an increasingly lower risk of metastatic prostate cancer and dying from the disease as men with low initial PSA levels age, the researchers suggest PSA testing three times between ages 44 and 60 for men with low PSA levels. This means that about half of men would have less frequent testing and the other half with higher PSA levels would be screened more often.

What this means for patients

“Doctors need a better way to accurately identify men at high risk for prostate cancer who need aggressive monitoring and those at low-risk of the disease who can be safely spared from frequent testing,” said lead author Hans Lilja, MD, PhD, Attending Research Clinical Chemist at Memorial Sloan-Kettering Cancer Center in New York. “Our results suggest that as many as half of men can safely undergo as few as three PSA tests in their lifetime. Such a testing schedule might spare these men from unnecessary PSA testing.”

Questions to ask your doctor

  • What is my risk of prostate cancer?
  • Do you recommend screening for prostate cancer? At what age?
  • What do my PSA levels mean?

For More Information

Guide to Prostate Cancer

Cancer Screening