Refining Prostate Cancer Screening

Benign prostate enlargement and PSA levels are possible early indicators

(RxWiki News) There has been a great deal of confusion about prostate screening guidelines and recommendations. Two new studies may offer physicians more insight as to when and how to screen for the disease to reduce over-testing, over-diagnosis and over-treatment.

Two new Danish studies examined two risk indicators for prostate cancer which could change the way men are screened for the disease. The first study analyzed links between prostate cancer and benign prostate enlargement, called benign prostatic hyperplasia (BPH). The second study analyzed the association of a man's initial (baseline) prostate-specific antigen (PSA) level with later development of the disease.

"Talk to your doctor about what prostate cancer screening is right for you."

These two studies could help researchers and physicians in terms of medical evaluation and new cost-effective testing for prostate cancer. It would reduce over-diagnosis by determining if a patient is at a higher risk of developing prostate cancer because they have BPH and a high baseline (first) PSA level. A lower risk patient would not have BPH and a low baseline PSA level.

The first study examined five national registries of over 3 million Danish males and looked for any relationship between prostate cancer and BPH compared to men without BPH. Traditionally, BPH has not been considered a risk factor or a predictor for prostate cancer. However, BPH and prostate cancer share similar qualities such as glanduar growth due to increased hormone levels and can be treated with hormone therapies.

Analyzing 27 years of data, researchers determined that men with BPH were two to three times as likely to be at risk for prostate cancer, compared with men who did not have the condition. Additionally, risk for death from prostate cancer was increased two to eight times among men who had BPH.

According to researcher Dr. Stig Bojesen, previous studies were inconclusive. Dr. Bojesen is optimistic about future research in establishing the association between BPH and prostate cancer because this study delivered conclusive results over a large sample pool.

More research is needed to determine if BPH could, in fact, be a cause for prostate cancer or is simply a risk factor. 

In the second study, Danish researchers looked at blood samples between 1981 to 2009 of 4,383 men from the general population between the ages of 20 and 94 years old. Baseline PSA levels were measured and compared to later prostate cancer diagnosis and death. The study determined that baseline PSA levels could predict future cancer development and death from prostate cancer in the general population. 

Healthy men have low PSA levels, while elevated baseline levels may indicate a high risk for prostate cancer or other prostate complications. It was previously uncertain if high PSA levels could predict a higher risk of developing prostate cancer in the future.

In the sample, 170 men were later diagnosed with prostate cancer and 94 died from the disease. Over a 10-year period, men whose PSA levels ranged between 4.01 and 10.00 ng/ml had an11 to 22 percent risk of developing prostate cancer, whereas PSA levels above 10.00 increased the cancer risks to 37 to 79 percent.

Researchers say the wide range could be due to patients who may have developed sub-clinical prostate cancer before the testing period.

 Dr.David Ørsted, who led both studies at the Copenhagen University Hospital, was optimistic about these new risk indicators. According to Dr. Ørsted, "two large randomised studies have shown that the benefit of general screening for prostate cancer is limited...results indicate that physicians could focus screening efforts on men with higher baseline prostate specific antigen values, while men with lower levels could avoid having frequent and unnecessary diagnostic examinations."

These results were presented at the 2011 European Multidisciplinary Cancer Congress.

Research is considered preliminary until published in a peer-reviewed journal.

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Review Date: 
October 6, 2011