Cancer can be found earlier in high-risk men if more aggressive screening criteria used

May 15 2005

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.

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