www.bmj.com/content/346/bmj.f2023"In contrast, the risk of metastases within 15 years was close to threefold higher (1.6%) for men in the highest 10th at age 45-49, and close to tenfold higher (5.2%) at age 51-55, suggesting that not starting PSA based screening until age 51-55 would leave an important proportion of men at a considerably increased risk of later being diagnosed with an incurable cancer."
"Measurement of PSA concentration in early midlife can identify a small group of men at increased risk of prostate cancer metastasis several decades later. Careful surveillance is warranted in these men. Given existing data on the risk of death by PSA concentration at age 60, these results suggest that three lifetime PSA tests (mid to late 40s, early 50s, and 60) are probably sufficient for at least half of men."
"There is now evidence that PSA screening is associated with reduced mortality from prostate cancer in men who would not otherwise be screened,1 2 although this comes at considerable harms in terms of the number of men who need to be screened, undergo biopsy, and be treated to prevent one man experiencing prostate cancer metastasis or dying.
That said, PSA screening is not a single intervention and men can be screened in different ways. There is surprisingly little evidence to support many aspects of contemporary screening guidelines. In particular, the age at which screening starts and the frequency of PSA testing is rarely justified in terms of empirical data. Recent evidence has suggested that a single PSA measurement can predict the long term risk of clinically relevant prostate cancer.3 4 5 6 This suggests that a baseline concentration could be used to determine whether a man might benefit from subsequent PSA tests and, if so, when these should be administered."
Post Edited (davidg) : 5/12/2013 11:00:48 AM (GMT-6)