Serial prostate-specific antigen screening may reduce risk of recurrence

Serial PSA screening may play a role in improving outcomes for patients who are diagnosed with prostate cancer, according to researchers at Brigham and Women’s Hospital in Boston.

“Men who were serially screened were diagnosed at an earlier stage and with more favorable PSA levels than men who had not had serial screening prior to diagnosis,” said Paul Nguyen, MD, lead author of the study, which was published in Cancer (2008; 113:3146-52). “This supports the notion that serial PSA screening could lead to the diagnosis of prostate cancers at more curable stages, which could potentially result in lower death rates from prostate cancer.”

Researchers evaluated nearly 2,000 men with prostate cancer who had radical prostatectomy. Patients were separated into two groups: those who had a history of regular, repeated PSA screenings before being diagnosed with prostate cancer, and those who were diagnosed with prostate cancer as a result of their first PSA screening. Men who had had PSA screening at regular intervals prior to their diagnosis had a substantially lower risk of recurrence than did men who had not had prior serial screenings. This effect remained significant, even when the analysis was controlled for stage, PSA level, and Gleason score.

“This research adds to the growing body of evidence showing the success of PSA screening,” said Anthony D’Amico, MD, PhD, senior author. “Without serial PSA screening, recurrence rates of prostate cancer after surgery are 80% higher.”

A separate, related study, which will be published in an upcoming issue of the Journal of Urology, found that a PSA of 1.5 ng/mL or greater in men older than 50 years represents an indicator for greater than average future risk of prostate cancer, according to Fritz H. Schröder, MD, and colleagues at Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.

The study included men 55 to 70 years old at the first and second screening rounds 4 years apart in the Rotterdam Section of the European Randomized Study of Screening for Prostate Cancer. The proportion of men with a positive prostate biopsy (initiated for a PSA of 3.0 ng/mL or greater) and the mean population PSA were calculated. Multivariate modeling was conducted using a proportional odds regression model to establish significant predictors of a positive biopsy from round one to round two of screening.

Among men with no previous prostate biopsy, the 4-year risk of prostate cancer was 5.1%, which was associated with a mean PSA of 1.5 ng/mL at the first screening. An increased PSA was a highly significant predictive factor for biopsy detectable prostate cancer 4 years later. Increasing total prostate volume and a previous negative biopsy were associated with a significant reduction in risk of a positive prostate biopsy 4 years later