MedWire News: Prostate-specific antigen (PSA) screening may be feasibly discontinued in African–American (AA) and Caucasian American (CA) men aged between 75 and 80 years whose initial PSA levels are less than 6 ng/ml and 3 ng/ml, respectively, report researchers.
These men are unlikely to be diagnosed with high risk prostate cancer or to die from the disease, the study findings show.
“Although there is considerable agreement that older men are unlikely to benefit from PSA testing, PSA screening for prostate cancer still remains common even in men with limited life expectancy,” explain Judd Moul and colleagues from Duke University Medical Centre in Durham, North Carolina, USA.
The study included 2128 men who were aged between 75 and 80 years when their first PSA measurement was taken. In total, 408 of the men were AA and 1720 were CA.
The researchers examined initial PSA levels among the cohort to determine the risk for prostate cancer detection, rates of high-risk disease, and death from prostate cancer, taking into account age and ethnicity.
Using a PSA level of 0.0–2.9 ng/ml as a reference, the researchers observed a 1.9-fold increase in the relative risk for prostate cancer detection among CA men with a PSA level of 3.0–5.9 ng/ml. However, no significant increase was seen in AA men with this PSA level.
Among men whose initial PSA levels were 6.0–9.9 ng/ml, the relative risk for prostate cancer detection increased 4.1-fold and 9.3-fold for CA and AA men, respectively.
A total of 17 AA men died after a median follow-up of 3.3 years, all of whom had an initial PSA level of 6 ng/ml or more. In contrast, 12 of the 14 CA men who died had PSA levels of 3 ng/ml or above, while the remaining two had levels below 2 ng/ml.
Moul et al conclude: “AA men with initial PSA below 6 ng/ml and CA men with initial PSA below 3 ng/ml between 75 and 80 years of age are unlikely to be diagnosed with high risk prostate cancer or death from prostate cancer.”
“It may be safe to discontinue PSA screening in these men,” the team adds in the journal Urology.
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