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A recent analysis showed that early-stage, but aggressive (grows and spreads quickly) prostate cancer is more likely to be detected in black men and men older than 75. Generally, the percentage of men with this type of prostate cancer is very small (about 1 man out of 8,000 men develops this type of prostate cancer). Because this stage of prostate cancer causes no symptoms and cannot be felt during a physical exam or seen on imaging tests, it is only detected through prostate specific antigen (PSA) testing. PSA is a substance in the blood that is primarily made by the prostate gland. It can be found in higher-than-normal levels in men with various prostate conditions, including prostate cancer, benign (noncancerous) prostatic hyperplasia (BPH, an enlarged prostate), and inflammation or infection of the prostate.
There is controversy about using the PSA test to look for prostate cancer in men with no symptoms of the disease. Although the PSA test has been shown to lower death rates from prostate cancer by finding prostate cancer earlier, it also has increased the number of unnecessary biopsies and treatments. A biopsy is the removal of a small amount of tissue to look for cancer cells. Because of these risks, the U.S. Preventive Services Task Force (USPSTF) recommended against PSA screening for men in the general U.S. population.
In this study, researchers analyzed information from 70,345 men with early-stage prostate cancer who were diagnosed by PSA testing. Based on the chance that the disease would grow and spread, the cancer was divided into low, intermediate, and high-risk groupings. Researchers found that about 40% of men who were diagnosed with high-risk, early-stage prostate cancer were older than 75. They were also more likely to have intermediate-risk disease, when compared with patients younger than 50. In addition, black men were nearly two times more likely than white men to develop high-risk prostate cancer.
What this means for patients
“If we stop PSA screening altogether, we have no other way to detect this form of prostate cancer early enough to have the best chance of helping this group of patients with high-risk disease,” said lead author Hong Zhang, MD, PhD, Associate Professor of Radiation Oncology at University of Rochester in New York. “The findings of this study will help physicians and certain patients make more informed decisions on whether or not they want to have PSA testing.” Although this study has highlighted that some men may be more likely to develop a faster-growing prostate cancer, more research is needed to find out if detecting and treating these cancers lengthens men’s lives. ASCO recommends that you discuss the risks and benefits of PSA testing with your doctor if you are expected to live longer than 10 years. To help you discuss PSA testing, ASCO provides a Decision Aid on prostate cancer testing.
Questions to Ask Your Doctor
- What is my risk of prostate cancer?
- What are the risks and benefits of PSA testing?
- Is PSA testing appropriate for me?
- If my PSA test is abnormal, what happens next? Will I need a biopsy or more testing?
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