Change in PSA levels over time can predict aggressive prostate cancer

Abstract

Measurements of prostate-specific antigen (PSA) taken over time versus only 1 measurement appear to improve the accuracy of detecting aggressive prostate cancer, according to a Kaiser Permanente study published in the British Journal of Urology International.1 Researchers examined the electronic health records of nearly 220,000 men aged 45 years and older over a 10-year period who had at least 1 PSA measurement and no previous diagnosis of prostate cancer. They learned that annual percentage changes in PSA more accurately predicted the presence of aggressive prostate cancer but only marginally improved the prediction of the disease overall. The use of a single PSA screening, which is considered controversial, may lead to unnecessary prostate biopsies and treatments because it does not distinguish that well between slow-growing and aggressive disease, according to Lauren Wallner, PhD, the study's lead author and a research fellow at Kaiser Permanente Southern California's department of research and evaluation. Study participants experienced on average a 2.9% change in PSA levels per year, and the rate of change in PSA increased modestly with age. Dr. Wallner notes that the study results could provide clinicians with a better way to differentiate between men with aggressive cancer and those with a slow-growing cancer who may not need treatment. Although she does not suggest that patients seek out additional PSA measurements, she says those who have had multiple PSAs should consider discussing the change in their levels with their physician when deciding on future treatments.