Should the UK lower the age for prostate cancer detection?

Prostate cancer screening occurs in many countries ahead of evidence from ongoing trials. In many countries, early detection (including the UK, when practised), and opportunistic screening commences at 50 years, but a lower age limit has recently been adopted in the USA based on two studies that found elevated prostate specific antigen (PSA) levels in men in their 40s was associated with subsequent prostate cancer.

So a team of UK researchers set out to investigate the feasibility of prostate cancer testing, disease prevalence and characteristics in a random group of younger men. Their findings are published on bmj.com today.

The study involved 473 men aged 45-49 years randomly selected from eight general practices in one UK city.

Of 442 men (34%) who agreed to PSA testing, 54 (12%) had an elevated PSA result. These men were invited for further testing (an ultrasound-guided prostate biopsy, a repeat PSA test, and a digital rectal examination).

Ten prostate cancers were detected (a 2.3% detection rate, similar to that in older men). The five men whose tumours were potentially risky to health agreed to have one of three treatment options (radiotherapy, surgery, or active monitoring).

This study shows that men younger than 50 years will accept prostate cancer testing, but at a much lower rate than older men, say the authors, so if screening were introduced, greater efforts would be needed to maximize uptake in this age group.

If the UK male population aged 45-49 years (2,236,000) were to undergo PSA screening they estimate that 272,905 men would have a raised PSA and of these 51,449 would have prostate cancer.

Some of these cancers may benefit from treatment, they say, but this has to be set against the likely distress caused to the 221,456 men with negative biopsy results and the risks of over-treatment and associated side-effects to those diagnosed with cancer.

This study will inform the debate about PSA thresholds and age limits only if prostate cancer screening is proven to be effective in ongoing trials, they conclude.

Until the results from ongoing trials are available, policy should advocate informed discussion between clinicians and patients about the benefits, potential harms, and limitations of prostate cancer screening, says an accompanying editorial.

Source: British Medical Journal

Health risk behaviors associated with lower prostate specific antigen awareness
According to a study conducted at Columbia University Mailman School of Public Health, health risk behaviors such as smoking and obesity are associated with lower awareness of the Prostate Specific Antigen (PSA), which could lead to a lower likelihood of undergoing actual prostate cancer screening. Although previous studies have explored predictors of PSA test awareness, this is the first research to focus on health risk behaviors, such as smoking, physical inactivity, obesity, and excessive alcohol consumption. The study findings were reported in the August issue of The Journal of Urology.
Hair on a man's head offers clues about prostate cancer
Some of the drugs given to many men during their fight against prostate cancer can actually spur some cancer cells to grow, researchers have found. The findings were published online this week in a pair of papers in the Proceedings of the National Academy of Sciences.
Prostatectomy improves outcome of some men with prostate cancer over watchful waiting
Men with early prostate cancer who undergo radical prostatectomy have a lower rate of death due to prostate cancer than men who are followed without treatment, known as watchful waiting, according to a randomized controlled trial published in the August 12 online issue of the Journal of the National Cancer Institute. The benefit from the surgery, with respect to prostate cancer death rates, remained constant beyond 10 years, but the overall death rates in the two groups were not statistically different. The applicability of the results to the current generation of prostate cancer patients is unclear, however, because few of the cancers treated in the trial were discovered by PSA (prostate-specific antigen) screening, a practice that is now widespread.
Study finds more PSA screening awareness needed among high-risk groups
In one of the first examinations of PSA screening in younger men, a study published by researchers at Duke Medicine's Prostate Center finds that one-fifth of men under age 50 reported undergoing a prostate specific antigen (PSA) test to detect prostate cancer in the previous year, yet only one in three young black men reported ever having a PSA test in the previous year.
1 in 5 young men has had recent prostate cancer test
A new analysis finds that one in five men in their 40s has had a prostate specific antigen (PSA) test within the previous year and that young black men are more likely than young white men to have undergone the test. The study, published in the September 15, 2008 issue of Cancer, a peer-reviewed journal of the American Cancer Society, provides valuable information as experts discuss possible changes to prostate cancer screening recommendations.
PSA screening may be biased against obese men, leading to more aggressive cancers
Testing men for elevated levels of prostate-specific antigen (PSA) in the blood -- the gold standard screening test for prostate cancer -- may be biased against obese men, whose PSA levels tend to be deceptively low. And this bias may be creating more aggressive cancers in this population by delaying diagnosis, according to a new study led by investigators in the Duke Prostate Center and the Durham Veterans Affairs (VA) Medical Center.
Exposure to Agent Orange linked to prostate cancer in Vietnam veterans
UC Davis Cancer Center physicians today released results of research showing that Vietnam War veterans exposed to Agent Orange have greatly increased risks of prostate cancer and even greater risks of getting the most aggressive form of the disease as compared to those who were not exposed.
Counting tumor cells in blood predicts treatment benefit in prostate cancer
Counting the number of tumor cells circulating in the bloodstream of patients with castration-resistant prostate cancer can accurately predict how well they are responding to treatment, new results show.

Should the UK lower the age for prostate cancer detection?

Related stories:

News discussion: