Treating Prostate Cancer in Men with Low Prostate-Specific Antigen Levels; Most men had low-risk disease but received aggressive therapy

Friday, 20/08/2010  |   Prostate Cancer  |  1 comment

Most prostate cancer is now detected at a localised stage, presumably because of screening for prostate-specific antigen (PSA), and the 5-year survival rate for patients with local disease is nearly 100%. Some experts are now concerned about over-diagnosis and overly aggressive treatment, yet others argue for lowering the PSA threshold for biopsy even further.

To explore this issue, researchers used a national cancer epidemiology database to assess the care of nearly 124,000 patients who had prostate cancer that was diagnosed between 2004 and 2006. Among the 14% of men with PSA levels 4.0 ng/mL, 54% had low-risk disease (stage T2a; Gleason score, 6). Of all cancer patients with PSA levels 4.0 ng/mL, 44% were treated with radical prostatectomy, and 33% received radiation therapy. The likelihood of aggressive management rose as tumour stage or Gleason score increased, but little difference in treatment pattern occurred with rising PSA level.

In a recent European trial of PSA screening, 48 patients had to be treated to prevent 1 prostate cancer death, and in a Scandinavian trial, radical prostatectomy was not superior to watchful waiting in older men (age, >65) with low-risk prostate cancer. These results raise further concerns about over-diagnosis and over-treatment of prostate cancer patients with low PSA levels. Editorialists focus in particular on the value of active surveillance, as opposed to aggressive therapy, in those patients who have PSA levels 10.0 ng/mL, stage T2a, and Gleason score 6.

Shao, Y.H., Albertsen, P.C., Roberts, C.B., Lin, Y., Mehta, A.R., Stein, M.N., DiPaola, R.S. & Lu-Yao, G.L. Risk profiles and treatment patterns among men diagnosed as having prostate cancer and a prostate-specific antigen level below 4.0 ng/mL. Archives of Internal Medicine. 2010 Jul 26; 170:1256. (

Hoffman, R.M. & Zeliadt, S.B. The cautionary tale of PSA testing. Archives of Internal Medicine. 2010 Jul 26; 170:1262. (

One Comment

  1. Hao
    Aug 20, 2010

    Thank you Daniel Weber, I found this very interesting.

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