Prostate-specific antigen at or before age 50 as a predictor of advanced prostate cancer diagnosed up to 25 years later: A case-control study

Abstract

BackgroundBased on a large, representative unscreened cohort from Malmö, Sweden, we have recently reported that a single prostate-specific antigen (PSA) measurement at or before age 50 is a strong predictor of prostate cancer occurring up to 25 years subsequently. We aimed to determine whether this association holds for advanced cancers, defined as clinical stage T3 or higher, or skeletal metastasis at the time of the cancer diagnosis.MethodsIn 1974–1986 blood samples were obtained from a cohort of 21,277 men aged up to 50. Through 1999, 498 men were diagnosed with prostate cancer, and of these 161 had locally advanced or metastatic prostate cancers. Three controls, matched for age and date of venipuncture, were selected for each case. Conditional logistic regression was used to test associations between molecular markers and advanced cancer.ResultsMedian time from venipuncture to diagnosis was 17 years. Levels of all PSA forms and hK2 were associated with case status. Total PSA was a strong and statistically significant predictor of subsequent advanced cancer (area under the curve 0.791; p < 0.0005). Two-thirds of the advanced cancer cases occurred in men with the top 20% of PSA levels (0.9 ng/ml or higher).ConclusionA single PSA test taken at or before age 50 is a very strong predictor of advanced prostate cancer diagnosed up to 25 years later. This suggests the possibility of using an early PSA test to risk-stratify patients so that men at highest risk are the focus of the most intensive screening efforts.

Serum thymidine kinase 1 reflects the progression of pre-malignant and malignant tumors during therapy

“…For pancreatic cancer, it is recommended that CA 19-9 be determined every 1-3 months in patients with locally advanced or metastatic diseases receiving active therapy. However, the predictive ability of serum tumor markers for response to anticancer therapy is still controversial, and an accurate appraisal of their individual characteristics must be performed (6). Furthermore, multivariate analysis of different studies show that serum tumor markers fluctuate more than imaging techniques.…”

“…Since 1960, a number of potential sensitive and specific serum markers have been investigated for their utility in the detection of invisible tumors, i.e., inaccessible malignancies occurring ahead of imaging or palpable assessment. Examples of such serum markers are CEA, CA19.9 (1-3), CA125 (4), AFP (5) and PSA (6), all of which are widely used in clinical practice today. Another example is CA15.3, which has proven useful in patients with metastatic breast cancer, when response to systemic therapy cannot be assessed (4,7).…”

825 Complications of initial prostate biopsy in a European randomized screening trial

“…However, the rapid half-life of lidocaine suggests that this may be unlikely to have a significant impact on persistent pain experienced several days after biopsy. Additionally, cultural perceptions and management of pain may differ [18,19], so our findings are not directly applicable in another population. Finally, men participating in ERSPC Rotterdam may be healthier than men in the general population [20], such that the complication rates might be underestimated.…”

The Risks and Benefits of Current Treatment Options for Prostate Cancer and Future Possibilities in Advanced Imaging and Targeted Therapy: A Review

“…Despite these complications, PSA concentration has been strongly correlated with prostate cancer metastasis 25-30 years after screening, suggesting that early testing is useful for identifying patients with the highest risk [21,22]. Vickers et al [22] reports a 15-year risk of prostate cancer metastasis to be 0.09% from ages 45-49 and 0.28% from ages 51-55, supporting the conclusion that just three lifetime PSA tests would be sufficient for detecting clinically significant cancer in at least 50% of the male population.…”