High PSA levels in middle-age men could indicate higher risk for prostate cancer

A new study published in the Journal of Clinical Oncology has found that men who have higher-than-normal prostate-specific antigen (PSA) levels in middle age are more likely to have fatal prostate cancer later in life.

According to an editorial article accompanying the study, this U.S.-based confirmation of earlier Swedish findings could help justify the possible “significant harms (such as infection or biopsy complications) of prostate cancer screening in younger-ish men."

The study examined the baseline PSAs of 945 male doctors between the ages of 40 and 59, starting in 1982, and then followed up on their health outcomes for 30 years. Two-hundred and thirty-four of those participants had prostate cancer, 71 cases of which became lethal. The research found that among the men with the lethal cases of prostate cancer, nearly three-quarters of them had had higher-than-normal PSAs in middle age.

 “A total of 82 percent, 71 percent and 86 percent of lethal cases occurred in men with PSA above the median at ages 40 to 49, 50 to 54, and 55 to 59 years, respectively,” the study authors wrote.

More than 90 percent of all lethal prostate cancers occurred in men who PSAs higher than the median between ages 40 and 49. (According to the study, the median PSA for the control group of that age was 0.68.) Men who had PSAs lower than that median in that age group had a less than 0.5 percent risk of developing deadly prostate cancer within the course of the 30 years of the study.

This finding could mean that the possible risks of prostate cancer screening in middle age are worth it in some men with other risk factors, according to the study authors. Even family history does not predict possible fatal prostate cancer occurrence as well as PSA measurements, the article explained.

As the editorial article noted, early screening has been associated with higher diagnosis and possibly unnecessary treatment of less severe cases of prostate cancer, and so was recommended against by the U.S. Preventative Services Task Force in 2012. But now this study shows such screening could also catch earlier warning signs of lethal prostate cancer and help physicians’ patients make more informed decisions about performing biopsies or beginning treatment.