Recommended prostate-specific antigen testing intervals for the detection of curable prostate cancer

H. B. Carter, J. I. Epstein, D. W. Chan, J. L. Fozard and J. D. Pearson
Department of Urology, Johns Hopkins Hospital, Baltimore, Md 21287-2101, USA. hcarter@gwgate1.jhmi.jhu.edu

OBJECTIVE: To evaluate prostate-specific antigen (PSA) testing intervals that maintain the detection of curable cancer and reduce unnecessary testing. DESIGN AND PATIENTS: Historical prospective study of serial PSA measurements at 2- and 4-year intervals from frozen serum samples of 40 men who eventually developed prostate cancer and 272 men without prostate cancer who were participants in a prospective aging study (Gerontology Research Center of the National Institute on Aging, the Baltimore Longitudinal Study of Aging) and the case series of 389 consecutive men treated surgically for nonpalpable prostate cancer. MAIN OUTCOME MEASURES: Probability of a PSA conversion to 4.1 to 5.0 ng/mL and to greater than 5.0 ng/mL at 2 and 4 years and probability of detecting curable prostate cancer by age and PSA level. RESULTS: When the pretreatment PSA level was less than or equal to 4.0 ng/mL, nonpalpable prostate cancers were highly likely (34/36, 94%) to be curable (organ-confined or capsular penetration with Gleason score < 7 and negative margins), and the majority (25/36, 69%) were small cancers (confined tumor < or = 0.5 cm3 with no Gleason pattern 4 or 5). When the pretreatment PSA level was greater than 4.0 ng/mL and less than or equal to 5.0 ng/mL, cancers were highly likely to be curable (32/36, 89%), and a minority were small cancers (12/36, 33%). When the pretreatment PSA level was greater than 5.0 ng/mL, 96 (30%) of 317 cancers were noncurable. The PSA conversion (for cancer cases) to a level at which cure is less likely (> 5.0 ng/mL) is rare (0%) after 2 or 4 years when the initial PSA is less than 2.0 ng/mL. PSA conversion to a range at which cancers are likely to be curable and less likely to be small (4.1-5.0 ng/mL) is rare after 2 years (0%-4%) when the baseline PSA level is less than 2.0 ng/mL but common when the baseline PSA level is between 2.1 and 3.0 ng/mL (27%) or 3.1 and 4.0 ng/mL (36%). CONCLUSIONS: These data suggest that for men with no cancer suspected on digital rectal examination, a PSA level of 4.0 to 5.0 ng/mL is an acceptable range for maintaining the detection of curable prostate cancer and a 2-year PSA testing interval is not likely to miss a curable prostate cancer when the initial PSA level is less than 2.0 ng/mL. Recognizing that 70% of a screened population between the ages of 50 years and 70 years have PSA levels less than 2.0 ng/mL, elimination of annual PSA testing for these men would result in large health care cost savings.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pathologic Characteristics of Cancers Detected in the Prostate Cancer Prevention Trial: Implications for Prostate Cancer Detection and Chemoprevention
Lucia et al.
Cancer Prevention Research 2008;1:167-173.
ABSTRACT | FULL TEXT  

Is Prostate-Specific Antigen Velocity Useful in Early Detection of Prostate Cancer? A Critical Appraisal of the Evidence
Etzioni et al.
JNCI J Natl Cancer Inst 2007;99:1510-1515.
ABSTRACT | FULL TEXT  

Interval Cancers in Prostate Cancer Screening: Comparing 2- and 4-Year Screening Intervals in the European Randomized Study of Screening for Prostate Cancer, Gothenburg and Rotterdam
Roobol et al.
JNCI J Natl Cancer Inst 2007;99:1296-1303.
ABSTRACT | FULL TEXT  

Detection of Prostate Cancer at Low and Intermediate Serum Prostate-Specific Antigen Levels in a Country with a Low Incidence of Prostate Cancer
Lee et al.
Jpn J Clin Oncol 2006;36:376-380.
ABSTRACT | FULL TEXT  

Assessing risk: does this patient have prostate cancer?
Carter
JNCI J Natl Cancer Inst 2006;98:506-507.
FULL TEXT  

Individualized Screening Interval for Prostate Cancer Based on Prostate-Specific Antigen Level: Results of a Prospective, Randomized, Population-Based Study
Aus et al.
Arch Intern Med 2005;165:1857-1861.
ABSTRACT | FULL TEXT  

Improved Detection of Prostate Cancer Using Classification and Regression Tree Analysis
Garzotto et al.
JCO 2005;23:4322-4329.
ABSTRACT | FULL TEXT  

Prostate Cancers in Men with Low PSA Levels -- Must We Find Them?
Carter
NEJM 2004;350:2292-2294.
FULL TEXT  

Second Round Results of the Finnish Population-Based Prostate Cancer Screening Trial
Makinen et al.
Clin. Cancer Res. 2004;10:2231-2236.
ABSTRACT | FULL TEXT  

Screening for Prostate Cancer: An Update of the Evidence for the U.S. Preventive Services Task Force
Harris and Lohr
ANN INTERN MED 2002;137:917-929.
ABSTRACT | FULL TEXT  

Pathologic Features of Prostate Cancer Found at Population-Based Screening With a Four-Year Interval
Hoedemaeker et al.
JNCI J Natl Cancer Inst 2001;93:1153-1158.
ABSTRACT | FULL TEXT  

Comparative Efficiency of Prostate-Specific Antigen Screening Strategies for Prostate Cancer Detection
Ross et al.
JAMA 2000;284:1399-1405.
ABSTRACT | FULL TEXT  

PSA screening: a view from the front lines
Greiver et al.
CMAJ 2000;162:789-790.
FULL TEXT  

HOW OFTEN SHOULD PSA LEVELS BE CHECKED?
JWatch General 1997;1997:4-4.
FULL TEXT