Prostate cancer exists in 25% of high-risk men with 'normal' PSA levels, study

Main Category: Prostate / Prostate Cancer
Article Date: 16 May 2005 - 9:00 PDT

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Men at high risk of developing prostate cancer should undergo aggressive screening for the disease. That is the recommendation following a Fox Chase Cancer Center study of 520 men at high-risk of developing prostate cancer in which 25 percent were diagnosed with the disease despite having a low PSA. The findings were presented today at the American Society of Clinical Oncology 41st Annual Meeting.

"This study demonstrates that we can find cancer earlier in high-risk men if we use more aggressive screening criteria," said Andre Konski, M.D., clinical director of the Prostate Cancer Risk Assessment Program at Fox Chase and lead investigator of the study. "Men at high risk of prostate cancer are more likely to develop the disease at a younger age. Catching the cancer early before it has spread is critical to curative treatment."

Today'sreport detailed the results of a study involving the first 520 men enrolled in Fox Chase's Prostate Cancer Risk Assessment Program between 1996 and 2004 (200 Caucasians, 315 African-Americans and five others). African-American men and men with a family history of prostate cancer who are between the ages of 35 and 69 are eligible to enroll in the Prostate Cancer Risk Assessment Program. Caucasian men testing positive for the BRAC1 gene are also eligible.

"Our study criteria dictated that men with an abnormal digital rectal exam and a PSA level between 2 and 4 would receive a biopsy," explained Konski. "While an abnormal digital rectal exam could trigger a physician's concern about the possible presence of cancer, the low PSA level would not usually raise suspicions. A PSA level between 2 and 4 would not warrant a biopsy according to traditional screening guidelines." Of the 520 men, a total of 75 men (44 African-American and 31 Caucasian) underwent 101 biopsies. The median age at biopsy was 56 (37 to 73). The median PSA at biopsy was 3.5 (0.4-53.6 ng/ml).

"We found prostate cancers in 45 percent of these men," said Konski. "Twenty-six percent of these men had a Gleason score of seven or higher, indicating aggressive cancers. What's more surprising is that 25 percent of the men who were diagnosed had a PSA of 2.5 or lower." This PSA level falls below the new guidelines adopted last year by the National Comprehensive Cancer Network and the American Urological Association, suggesting biopsy when PSA levels exceed 2.5.

The Fox Chase study did not evaluate if earlier diagnosis of these men increased overall survival.

The Prostate Cancer Risk Assessment Program offers education, risk assessment, screening and an opportunity to participate in innovative prostate cancer research to men who are at an increased risk of the disease because of their family history or their race. This unique program is designed for men aged 35 to 69 who have increased risk of prostate cancer because of family history - a father, brother, or son with prostate cancer - or because they are African American, with or without a family history of prostate cancer.

Konski's Fox Chase co-authors include radiation oncologist Steven J. Feigenberg, M.D., assistant clinical director for the Prostate Cancer Risk Assessment Program; research nurse Amy Bower, R.N., M.S.N., O.C.N.; data manager Susan Raysor; research biostatistician Debra Eisenberg; urologic surgical oncologist Robert G. Uzzo, M.D.; urologic surgical oncology chief Richard E. Greenberg, M.D.; radiation oncologist Eric M. Horwitz, M.D.; radiation oncology chairman Alan Pollack, M.D., Ph.D.; retired radiation oncology chairman Gerald E. Hanks, M.D.; and Prostate Cancer Risk Assessment Program director Deborah Watkins Bruner, PhD., along with pathologist Ila Mirchandani, M.D., of Temple University's Jeanes Hospital.

Fox Chase Cancer Center was founded in 1904 in Philadelphia as the nation's first cancer hospital. In 1974, Fox Chase became one of the first institutions designated as a National Cancer Institute Comprehensive Cancer Center. Fox Chase conducts basic, clinical, population and translational research; programs of prevention, detection and treatment of cancer; and community outreach. For more information about Fox Chase activities, visit the Center's web site at http://www.fccc.edu or call 1-888-FOX CHASE.

Contact: Karen C. Mallet
karen.mallet@fccc.edu
215-728-2700
Fox Chase Cancer Center
http://www.fccc.edu

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