In 2010, the National Comprehensive Cancer Network (NCCN) published revised guidelines for prostate cancer screening.
Two of the recommendations are:
- to perform annual screening for men in ther 40’s with a baseline PSA level greater than 1 and
- to consider prostate biopsy for men with a total PSA of 2.5 or less and negative DRE but whose PSA velocity exceeds 0.35 ng/mL in a year.
This article is based on a *study initiated to examine the application of these guidelines.
Men In Their 40’s
Our findings showed than among men in their 40’s, 64% had a baseline PSA level of less than 1 ng/mL and prostate cancer was exclusively diagnosed in this age group in men with baseline PSA levels of more than 1.
When race and family history were included in the equation, a baseline PSA of more than 1 for men in their 40’s was significantly associated with prostate cancer risk.
Also, the analysis confirmed a significantly lower prostate cancer-free survival rate for men in their 40’s with a baseline PSA of more than 1.
These results confirm that the majority of men in their 40’s have PSA levels of less than 1 ng/mL, and that a PSA of more than 1 ng/mL in the 40’s is indicative of significantly increased prostate cancer risk.
PSA Velocity of 0.35 In a Year
Among men of any age with PSA levels of 2.5 or less and negative DRE, the vast majority had a PSA velocity less than 0.35 ng/mL per year.
If the PSA velocity was more than 0.35 ng/mL per year, that statistic was associated with nearly 5-fold increased odds of prostate cancer.
A PSA velocity of more than 0.35 in one year was a statistically significant predictor of prostate cancer in an otherwise low-risk group.
Recommended NCCN Guidelines
Both baseline PSA measurements for men in their 40s and PSA velocity at low PSA levels, as suggested by the NCCN guidelines, are useful predictors of prostate cancer risk.
*Evaluation of National Comprehensive Cancer Network (NCN) Guidelines for Prostate Cancer Screening and Detection – supported in part by the URF, and presented at the recent AUA (American Urological Association)
William J. Catalona, MD; Gustavo Carvalhal, MD; Donghui Kan; and Stacy Loeb, MD