Prostate-Specific Antigen (PSA) And PSA Velocity For Prostate Cancer Detection In Men Aged Less Than 50 Years

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 16 Apr 2007 - 0:00 PDT

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UroToday.com- Both BPH and prostate cancer CaP can contribute to serum PSA levels. Younger men have less of a BPH contribution to overall PSA production and therefore, lowering PSA level thresholds in men aged <50 years may result in increased detection and treatment of early-stage CaP. Dr. Sun and associates at Duke University report on PSA kinetic data and optimized screening variables to recognize clinically significant CaP in men <50 years. Their work appears in the online version of the BJU International.

The Duke Prostate Center outcomes database includes >14,000 patients with CaP. From this, 904 men age <50 years were identified and 40 had CaP (4.4%) with a median age of 48 years. Of the 40 men, four had a family history of CaP and six had an abnormal prostate examination. The men <50 years without cancer served as age controls. Race distribution in the group with cancer and no cancer were similar.

For men aged >50 years and no cancer, the median PSA and PSA velocity (PSAV) were 5.1ng/ml and 0.25ng/ml/year, respectively vs. 6.3ng/ml and 1.78ng/ml/year in those with cancer. For men aged <50 years, the PSA and PSAV were 0.7ng/ml and 0.15ng/ml/year, respectively, for those without cancer, compared to 1.3ng/ml and 1.83ng/ml/year in those with cancer. Interestingly, the authors point out that the PSAV of 1.83ng/ml/year is well above the PSAV of 0.75 commonly applied and the total PSA level of 1.3ng/ml is well below the current AUA guideline of 4.0ng/ml.

Using receiver operator characteristic analysis, the break points in the PSA and PSAV curves were used to determine new ranges for biopsy in men aged <50 years, at 2.0-2.5ng/ml for PSA and 0.2-0.6ng/ml/year for PSAV. The sensitivity and specificity for a PSA level threshold of 4.0ng/ml was 61.3% and 97.7%, respectively for men aged <50 years and 71.3% and 85.2%, respectively for men aged >50 years. The sensitivity and specificity for a PSAV level threshold of 0.75ng/ml/year was 66.7% and 86.3%, respectively for men aged <50 years and 73.4% and 77.1%, respectively for men aged >50 years. The sensitivity and specificity for a PSA level threshold of 2.0-2.5ng/ml for men aged <50 years were 73.8-75% and 92.2-94.1%, and for a PSAV of 0.2-0.6ng/ml/year was 71.4-85.7% and 62.1-83.7%, respectively. For the 40 men diagnosed with CaP who were <50 years, a third were below the PSAV threshold of 0.75ng/ml/year and 38.5% were below the current PSA level threshold of 4.0ng/ml. Using a PSA level threshold of >2.5ng/ml and PSAV threshold of >0.60ng/ml/year for men <50 years, an additional 6 were detected with CaP and only 11 were missed.

The authors conclude that a PSA level of 2.0-2.5ng/ml for biopsy in men aged <50 years and a PSAV threshold lower than the traditional 0.75ng/ml/year is reasonable to apply.

Leon Sun, Judd W. Moul, James M. Hotaling, Edward Rampersaud, Phillipp Dahm, Cary Robertson, Nicholas Fitzsimons, David Albala and Thomas J. Polascik

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