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Target middle-aged men for PSA testing, say researchers

Middle-aged men should undergo routine prostate specific antigen (PSA) testing to identify their risk of developing prostate cancer later in life, say Swedish and US researchers.

The study

Swedish researchers analysed the association between PSA and long-term prostate cancer outcomes in men aged around 40 (n=3,979), mid to late 40s (n=10,357) or at age 44 to 51 years (n=12,1690 at baseline). It analysed PSA measurements in men with prostate cancer metastasis (cases) and compared them with controls and men not selected as controls in participants from the Malmo cohort.

The findings

After case notes were reviewed for death from prostate cancer or metastasis, some 44% (95% CI 34-53%) of deaths within 25 to 30 years occurred in men with a PSA concentration in the highest 10th of the distribution of concentrations at age 45 to 49 years (≥1.6 µg/L), with a similar proportion for the highest 10th at age 51 to 55 years (≥2.4 µg/L).

What does this mean for GPs?

The authors concluded: ‘Screening programmes can be designed to focus on men at highest risk, with three lifetime PSA tests between the ages of 45 and 60 years sufficient for at least half of the male population. This is likely to reduce the risk of overdiagnosis while still enabling early cancer detection among those most likely to gain from early diagnosis.’

BMJ 2013, online 16 Apr

Readers' comments (3)

  • Vinci Ho

    Good ,large case controlled study .Long period of time was covered as well.(PSA levels and records back to 1974 were reviewed).Scandinavian study.
    Practical questions were offered answers:
    (1)At what age is the best time to start screening?
    (2) How often should the test be repeated ?
    Patients with special risks e.g. BRCA 1 &2 gene mutations ,HOXB13 should be considered differently.

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  • No reference to the harms done as part of the investigation process. I, for one, won't be getting my PSA done

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  • Vinci Ho

    The study was particularly looking into how to strike the balance between causing harm due to unnecessary biopsies and picking up prostatic cancer just about early enough

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