Hopkins Study Recommends New Prostate Cancer Test Guidelines

May 14, 1997

Biennial Testing Recommended For Most Men

A team of researchers led by Johns Hopkins finds most men between 50 and 70 don't need an annual prostate specific antigen (PSA) test for prostate cancer because their risk of having a noncurable cancer that can be detected is so small.

"Many men need to be tested only once every two years, a change that could dramatically reduce the costs of prostate cancer screening in the United States," says H. Ballentine Carter, M.D., associate professor of urology at the Johns Hopkins Brady Urological Institute.

The study, published in the May 14 issue of the Journal of the American Medical Association, showed PSA testing every two years is sufficient to identify most men with curable prostate cancer even when a digital rectal examination (DRE) does not. During DRE, a physician feels the prostate and notes any abnormal swelling, which may represent cancer. PSA is a protein made by the prostate gland. Elevated levels of PSA in the blood indicate that prostate disease is present, but PSA levels alone do not prove whether the gland is cancerous.

"Our results suggest that annual testing for PSA in all men is not a cost-effective way to catch prostate cancer at an early, treatable stage," says Carter. The study was co-authored by researchers from the National Institutes of Health's National Institute on Aging (NIA) in Baltimore and Merck Research Laboratories (Blue Bell, Pa.)

Yearly PSA testing of men increases the number of results that falsely identify men with high levels of the protein, and may lead to further unnecessary tests, according to Carter. But reducing the frequency of testing also may leave some men with unidentified prostate cancer that would be caught by PSA testing.

The study concluded, however, that if a man's PSA level is less than 2 nanograms per milliliter at the first test, he isn't likely to develop incurable prostate cancer before being tested again in two years. A nanogram is a billionth of a gram (2 nanograms = 0.07 ounces). "Annual retesting in these men is not likely to save lives," says Carter. "So for these men, it's safe to wait an extra year. And because 70 percent of men age 50 to 70 have PSA levels less than 2, we can eliminate a lot of unnecessary testing."

"It was important to differentiate between important and unimportant cancers," says Carter. "Most men who die in their 90s have unimportant cancers in their prostate. These are cancers that have been growing extremely slowly, were never a threat to life and didn't require treatment."

"This study allows physicians to reduce the number of PSA tests that are being done unnecessarily," says Jay D. Pearson, Ph.D., senior epidemiologist at Merck Research Laboratories in Blue Bell, Penn. "PSA can be tested less frequently in men with PSA lower than 2 because there is little benefit to the patient and little chance of missing a curable cancer," says Pearson, a guest researcher at NIA.

The researchers also found that 89 percent of men with PSA levels between 4.0 and 5 micrograms per milliliter (1 microgram = 1 millionth of a gram) had curable cancers that required treatment, even though digital exams did not find the cancer. In addition, small, unimportant cancers not needing treatment were detected only 33 percent of the time.

"This means that a physician can feel confident that a man with a PSA between 4 and 5 who has prostate cancer, most likely has curable disease." says Carter. "But at the same time, the probability is small that the cancer is unimportant."

In the first part of the study, researchers measured PSA levels in blood samples of 40 men with prostate cancer from the Baltimore Longitudinal Study of Aging (BLSA), an ongoing, long-term study of aging conducted by the National Institute on Aging. These results were compared with blood samples from 272 men with no evidence of prostate cancer. The findings were used to determine how likely it was that men with a particular PSA level would have an increase in their PSA level. In a second part of the study, researchers determined the actual severity of prostate cancer at particular PSA levels in 389 men by analyzing information collected during and after surgery to treat the cancer at The Johns Hopkins Hospital.

Other authors of the study include Jonathan I. Epstein, Daniel W. Chan (Johns Hopkins); and James L. Fozard (Gerontology Research Center, National Institute on Aging, Baltimore).


Media Contact: Marc Kusinitz (410)955-8665
E-mail: mkusinit@welchlink.welch.jhu.edu

Johns Hopkins Medical Institutions' news releases are available on a PRE-EMBARGOED basis on EurekAlert at http://www.eurekalert.org and from the Office of Communications and Public Affairs'direct e-mail news release service. To enroll, call 410-955-4288 or send e-mail to bpalevic@welchlink.welch.jhu.edu or 76520.560@compuserve.com.

On a POST-EMBARGOED basis find them at http://hopkins.med.jhu.edu, http://infonet.welch.jhu.edu/news/news_releases, Newswise at http://www.ari.net/newswise or on CompuServe in the SciNews-MedNews library of the Journalism Forum under file extension ".JHM", Quadnet at http://www.quad-net.com or ScienceDaily at http://www.sciencedaily.com.

Johns Hopkins Medicine

Related Prostate Cancer Articles from Brightsurf:

Low risk of cancer spread on active surveillance for early prostate cancer
Men undergoing active surveillance for prostate cancer have very low rates - one percent or less - of cancer spread (metastases) or death from prostate cancer, according to a recent study published in the Journal of Urology®, an Official Journal of the American Urological Association (AUA).

ESMO 2020: Breast cancer drug set to transform prostate cancer treatment
A drug used to treat breast and ovarian cancer can extend the lives of some men with prostate cancer and should become a new standard treatment for the disease, concludes a major trial which is set to change clinical practice.

Major trial shows breast cancer drug can hit prostate cancer Achilles heel
A drug already licensed for the treatment of breast and ovarian cancers is more effective than targeted hormone therapy at keeping cancer in check in some men with advanced prostate cancer, a major clinical trial reports.

The Lancet: Prostate cancer study finds molecular imaging could transform management of patients with aggressive cancer
Results from a randomised controlled trial involving 300 prostate cancer patients find that a molecular imaging technique is more accurate than conventional medical imaging and recommends the scans be introduced into routine clinical practice.

Common genetic defect in prostate cancer inspires path to new anti-cancer drugs
Researchers found that, in prostate cancer, a mutation leading to the loss of one allele of a tumor suppressor gene known as PPP2R2A is enough to worsen a tumor caused by other mutations.

First prostate cancer therapy to target genes delays cancer progression
For the first time, prostate cancer has been treated based on the genetic makeup of the cancer, resulting in delayed disease progression, delayed time to pain progression, and potentially extending lives in patients with advanced, metastatic prostate cancer, reports a large phase 3 trial.

Men taking medications for enlarged prostate face delays in prostate cancer diagnosis
University of California San Diego School of Medicine researchers report that men treated with medications for benign prostatic hyperplasia (enlarged prostate) experienced a two-year delay in diagnosis of their prostate cancer and were twice as likely to have advanced disease upon diagnosis.

CNIO researchers confirm links between aggressive prostate cancer and hereditary breast cancer
The study has potential implications for families with members suffering from these types of tumours who are at an increased risk of developing cancer.

Distinguishing fatal prostate cancer from 'manageable' cancer now possible
Scientists at the University of York have found a way of distinguishing between fatal prostate cancer and manageable cancer, which could reduce unnecessary surgeries and radiotherapy.

Researchers find prostate cancer drug byproduct can fuel cancer cells
A genetic anomaly in certain men with prostate cancer may impact their response to common drugs used to treat the disease, according to new research at Cleveland Clinic.

Read More: Prostate Cancer News and Prostate Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.