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Age Can Affect PSA Reading And Prostate Cancer Diagnosis

Prostate specific antigen is a tumor marker, elevated level of which is strongly suggestive of prostate cancer in men. PSA testing is routinely used by doctors to spot early signs of prostate cancer, if any. A new study has now suggested that a different criterion may be needed for establishment of prostate cancer diagnosis in young men and those above 70 years of age.

The researchers from Duke University Medical Center analyzed more than 12,000 medical records of men who presented to the urology clinic and documented the raise of PSA levels. They argue that low threshold levels of the marker need to be set for men under 70.

The existing threshold for PSA velocity (PSAV) is 0.75 ng/ml/yr. A prostate biopsy is strongly indicated in men whose PSA levels increase by a margin of 0.75 in one year. The present study highlights that this may limit the prostate cancer diagnosis in men younger than 70.

The researchers further recommend that the optimal PSAV threshold be set at 0.4ng/l/yr for those under 60 and 0.6 ng/ml/yr for men between 60 and 70 years of age.

'Finding that PSA velocity is more effective when it is age-adjusted is very important, especially since the oldest of the Baby Boomers turn 60 this year. In the past few years, 60 or younger has become the peak age for prostate cancer diagnosis. Using PSAV makes it much more likely that we will detect cancers in men of this age,' concluded Dr. Judd W. Moul, lead author of the study.

Novel PSA Thresholds Proposed For Prostate Cancer BCR After Primary Treatment

Investigators have identified novel PSA thresholds for biochemical recurrence (BCR) at which prostate cancer-specific survival is equal following primary radiation therapy (RT) and radical prostatectomy (RP).

"Our results highlight that current BCR definitions are suboptimal for primary treatment comparison and present, for the first time, promising novel early endpoints suitable for further validation," Ugo Falagario, MD, of Karolinska Institutet in Stockholm, Sweden, and colleagues stated in a poster presentation at ASCO's 2025 Genitourinary Cancers Symposium in San Francisco, California.

The study was based on data from men with cT1-3 localized prostate cancer living in Stockholm, of whom 12,010 underwent RP and 5743 RT. Of these, 428 men died. Using the current definitions of BCR after primary treatment, the risk for prostate cancer death was 3.35-fold higher after RT compared with RP, the investigators reported. The current definition of BCR after RT is a PSA rise from nadir of 2 ng/mL, whereas after RP, it is a PSA level of 0.2 ng/mL.

Prostate cancer mortality risk only was equal when the PSA threshold after RT was lowered to PSA nadir plus 0.5 ng/mL and the PSA threshold after RP was raised to 0.5 ng/mL or higher with a PSA doubling time of 9 months or less, Dr Falagario's team reported.

The investigators adjusted their analyses for age at diagnosis, Charlson Comorbidity Index, baseline PSA, ISUP Gleason grade group at biopsy, cT stage, and treatment year. Median follow-up was 91 months.

"Our research group is dedicated to optimizing the definitions of biochemical recurrence (BCR) after active treatment for prostate cancer, with the goal of improving prognostic accuracy, enabling timely salvage interventions, refining risk stratification, and enhancing treatment comparisons," Dr Falagario stated in the poster on behalf of his team.

This article originally appeared on Renal and Urology News

References:

Falagario U, Pellegrino F, Carrieri G, Lantz A, Akre O, Wiklund P. PSA-based intermediate endpoints to compare radiotherapy and radical prostatectomy for the treatment of localized prostate cancer. Presented at ASCO's Genitourinary Cancers Symposium. February 13-15, 2025. San Francisco, California. Poster 366.

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