Should baseline PSA testing be performed in men aged 40 to detect those aged 50 or less who are at risk of aggressive prostate cancer?
Date
2011-09
Journal Title
Journal ISSN
Volume Title
Publisher
Health and Medical Publishing Group (HMPG)
Abstract
We aimed to evaluate the presenting features and
treatment outcome of prostate cancer in men aged <50 years, in
a region where prostate specific antigen (PSA) screening is not
readily available and most men present with symptoms.
Methods. We analysed the data of 1 571 men with prostatic
adenocarcinoma treated between January 1997 and December 2008
at our institution, a tertiary level public sector hospital serving a
largely indigent population. Statistical analysis was performed
using Student’s, the Mann-Whitney and Fisher’s exact tests where
appropriate (p<0.05 accepted as statistically significant).
Results. Of 1 571 men, 47 (3%) were aged <50 years. The
group aged <50 years, compared with that aged >50 years, had
a significantly greater proportion with poorly differentiated
adenocarcinoma (53%), locally advanced (stage T3 - 4) tumours (56%), haematogenous metastases (75%), significantly higher
serum PSA at diagnosis (mean 621, median 74 ng/ml) and shorter
survival.
Conclusions. Men aged <50 years presenting with symptoms
owing to prostate cancer had significantly higher-risk disease,
higher mean PSA, and poorer prognosis than men aged >50 years.
To diagnose prostate cancer at a potentially curable stage in men
aged <50 years, it is necessary to initiate baseline PSA testing at age
40 and 45 years, and to select high-risk men for PSA surveillance
in order to diagnose potentially curable cancer in those with a life
expectancy >20 - 25 years.
Description
The original publication is available at http://www.samj.org.za
Keywords
Prostate specific antigen (PSA), Prostrate cancer -- Diagnosis, Prostate cancer -- Overtreatment risk, Prostrate cancer -- Treatment
Citation
Heyns, C. F., Fisher, M., Lecuona, A. & Van Der Merwe, A. 2011. Should baseline PSA testing be performed in men aged 40 to detect those aged 50 or less who are at risk of aggressive prostate cancer? South African Medical Journal, 101(9), 642-644.