Men at high risk of developing prostate cancer should
undergo aggressive screening for the disease. That
is the recommendation following a Fox Chase Cancer
Center study of 520 men at high-risk of developing
prostate cancer in which 25 percent were diagnosed
with the disease despite having a low PSA. The findings
were presented today at the American Society of Clinical
Oncology 41st Annual Meeting.
"This study demonstrates that we can find cancer
earlier in high-risk men if we use more aggressive
screening criteria," said Andre Konski, M.D., clinical
director of the Prostate Cancer Risk Assessment Program
at Fox Chase and lead investigator of the study. "Men
at high risk of prostate cancer are more likely to
develop the disease at a younger age. Catching the
cancer early before it has spread is critical to curative
treatment."
Today'sreport detailed the results of a study involving
the first 520 men enrolled in Fox Chase's Prostate
Cancer Risk Assessment Program between 1996 and 2004
(200 Caucasians, 315 African-Americans and five others).
African-American men and men with a family history
of prostate cancer who are between the ages of 35
and 69 are eligible to enroll in the Prostate Cancer
Risk Assessment Program. Caucasian men testing positive
for the BRAC1 gene are also eligible.
"Our study criteria dictated that men with an abnormal
digital rectal exam and a PSA level between 2 and
4 would receive a biopsy," explained Konski. "While
an abnormal digital rectal exam could trigger a physician's
concern about the possible presence of cancer, the
low PSA level would not usually raise suspicions.
A PSA level between 2 and 4 would not warrant a biopsy
according to traditional screening guidelines." Of
the 520 men, a total of 75 men (44 African-American
and 31 Caucasian) underwent 101 biopsies. The median
age at biopsy was 56 (37 to 73). The median PSA at
biopsy was 3.5 (0.4-53.6 ng/ml).
"We found prostate cancers in 45 percent of these
men," said Konski. "Twenty-six percent of these men
had a Gleason score of seven or higher, indicating
aggressive cancers. What's more surprising is that
25 percent of the men who were diagnosed had a PSA
of 2.5 or lower." This PSA level falls below the new
guidelines adopted last year by the National Comprehensive
Cancer Network and the American Urological Association,
suggesting biopsy when PSA levels exceed 2.5.
The Fox Chase study did not evaluate if earlier
diagnosis of these men increased overall survival.
