Prostate Cancer May Be Predicted 10 Years Before Diagnosis

men with prostate cancer. All men in this study are participants in the BLSA, a longitudinal study of aging established in 1958. They return for follow-up visits every 2 years when they undergo a battery of tests including collection of blood samples. Four years before diagnosis, total PSA was significantly greater for men who developed prostate cancer (5.0ng/ml?0.9) compared to men with BPH (2.8ng/ml?0.3) and controls (0.8 ng/ml?0.1.) Free PSA levels were similar among groups at four years before diagnosis. However, the ratio of free to total PSA continuously decreased among cancer cases over the decade before prostate cancer diagnosis. At a time when total and free PSA levels were similar among groups (8 years before diagnosis), the ratio of free to total PSA was significantly lower for cancer cases (0.13?0.01) compared to BPH (0.17?0.01) and control cases (0.21?0.02). The values that most accurately detected prostate cancer were free to total PSA ratio of ?0.12 when total PSA was between 4.0 - 10.0ng/ml.

"The majority of men who have elevated PSA levels and have further diagnostic tests, such as prostate biopsies, do not have prostate cancer," says Dr. H. Ballentine Carter, a urologist at Johns Hopkins School of Medicine who worked on the study. Dr. Fozard adds, "This study shows that the ratio of free to total PSA may be useful in helping the physician to perdict whether prostate cancer is or is not developing." The American Cancer Society, the American Urological Society, and the American College of Radiology recommend that men have a PSA test and digital rectal exam annually, beginning at age 50. African American men and those with a family history of prostate cancer should have the same tests beginning at age 40. In 1996, an estimated 317,100 new cases of prostate cancer were diagnosed, and prostate cancer was responsible for an estimated 41,400 deaths. Prostate cancer rates are 37 percent higher for black men than white men. Between 1980 and 1990

Contact: Suzanne Lewis
NIH/National Institute on Aging

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