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PSA
Levels Mean More Extensive Prostate Disease In Older Men
May 31, 1999. -- In a study of prostate cancer at different
ages, Johns Hopkins researchers have found that at diagnosis, older men
have more extensive disease than younger men even if their prostate specific
antigen (PSA) levels are the same. PSA is a protein made by the prostate;
rising blood levels suggest that the prostate is enlarged or even cancerous.
"The finding shows that both doctors
and older men must be especially vigilant," says H. Ballentine Carter,
M.D., associate professor of urology. "The blood test results don't
necessarily mean the same level of disease when ages differ," he
said. The study, presented May 31 at the annual meeting of the American
Urological Association in San Diego, Calif., was done with cancers that
could not be detected by digital rectal exams.
The results are a new wrinkle on a long-standing
problem over deciding whether to do further testing on men with raised
PSA levels, Carter says. "Lowering the PSA threshold means you pick
up more small, harmless tumors. Raising the PSA threshold means you're
more likely to miss life-threatening tumors. The present study gives us
age as an additional guide in deciding when it might be worthwhile to
do further testing in men with non-palpable prostate cancer. At any particular
PSA level, a key factor in catching cancer when it is still curable is
the man's age."
| Age
in Years |
PSA
ng/Ml |
chance
of curable cancer |
| 40-50 |
4.0 |
89% |
| 61-73 |
4.0 |
78% |
|
|
| 40-50 |
8.1 to 10 |
73% |
| 61-73 |
8.1 to 10 |
49% |
These findings are of concern because
some advisors including David Bostwick, M.D., MacLennan. M.D. and Thayne
Larson M.D. in their book Prostate Cancer (published by the American
Society, 1999) say that "as a man gets older, what we consider a
normal PSA increases slightly." Age, which is a risk factor
for prostate cancer, sometimes is used as reassurance for not needing
to investigate a rising PSA (on grounds that in an older man, benign swelling
of the prostate likely accounts for some of the PSA). The Hopkins' study,
involving nearly five hundred men who all had prostate cancer, presents
a challenge to just this opinion. At every PSA level older men were more
likely to have more advanced disease.
The Hopkins team studied 492 men who had
undergone surgery to remove their prostates. The men were divided into
three age groups: (40-50, n=69; 51-60, n=227; 61-73, n=196) and five pre-treatment
PSA categories: (2.5-4.0, n=36; 4.1-6.0, n=100; 6.1-8.0, n=122; 8.1-10.0,
n=76; >10.0, n=135). Patients were considered curable if the cancer was
either confined to the prostate or had not spread outside the gland to
lymph nodes and the seminal vesicles.
For a given PSA range, increasing age was
associated with lower probability of cure. If a man 40 to 50 years old
had a PSA level of 4.0, for example, he had an 89 percent chance of having
curable cancer; but a man with the same PSA level who was 61 to 73 years
old had only a 78 percent chance of having a curable cancer. For PSA levels
of 8.1 to 10, the rates of curable cancer were 73 percent for men ages
40 to 50 and 49 percent for men ages 61 to 73.
Other authors of the study include Jonathan I. Epstein, Patrick C.
Walsh and Alan W. Partin.
July 5, 1999
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