Previously we revealed that a new tool may decide the necessity of undergoing a screening for prostrate cancer. Now, a team of experts shared that most men who are detected with prostrate cancer undergo aggressive therapy even if they have low PSA level and low-risk disease.
Previous analysis highlighted that more than 90 percent prostrate cancers were detected before the disease spread to other parts of the body. They also revealed that the five-year survival rate for these patients detected with localized disease is around 100 percent. Five-year survival rate across all stages of the disease augmented from 69 percent in 1975 to 99 percent in 2003.
Authors elucidate, “The tremendous improvement in survival has been attributed to early detection and treatment. However, there have been concerns about the potential over diagnosis and over treatment of localized prostate cancer. Despite these concerns, some researchers argue that the prostate-specific antigen (PSA) level is associated with a continuum of cancer risk and recommend lowering the 4-nanogram per milliliter threshold for biopsy.”
Data from the Surveillance, Epidemiology and End Results system was collected to examine current risk and treatment approaches for men with prostrate cancer and PSA levels. The analysis enlisted 123,934 men with newly detected prostate cancer from 2004 to 2006. Experts identified that 14 percent had PSA levels of 4 nanograms per milliliter or lower. The participant had less risk of high-grade cancer, however half of them were detected to have low-risk cancer.
The authors share, “Despite their lower risk of having clinically significant disease, treatment rates for men with PSA values of 4.0 nanograms per milliliter or lower were comparable to those of men presenting with PSA values between 4.0 and 20.0 nanograms per milliliter. More than 70 percent of men with PSA values lower than 20 nanograms per milliliter had their prostates removed via radical prostatectomy or had radiation therapy.
They further added, “Radical prostatectomy was performed on 44 percent of men with PSA values of 4.0 nanograms per milliliter or lower, 38 percent of men with PSA values between 4.1 and 10.0 nanograms per milliliter and 24 percent of men with PSA values between 10.1 and 20 nanograms per milliliter. Radiation therapy was performed on 33 percent of men with PSA values of 4.0 nanograms per milliliter or lower, 40 percent of men with PSA values between 4.1 and 10.0 nanograms per milliliter and 41.3 percent of men with PSA values between 10.1 and 20 nanograms per milliliter.”
Scientists recommend that if the threshold PSA value for biopsy were lowered from 4.0 to 2.5 nanograms per millimeter, the number of men facing abnormal PSA levels would double to around 6 million. They further revealed that 32 percent of men with abnormal PSA levels would be detected with prostrate cancer from needle biopsy. The current analysis highlighted that 82.5 percent of these 1.9 million men would seemingly receive curative treatments, whereas only 2.4 percent would have high-grade cancer.
Moreover, no evidence suggests that delaying biopsy until the PSA level reaches 4.0 nanograms per milliliter would result in an extreme number of non-curable disease cases. Findings underline that PSA levels are apparently not a precise basis for treatment decisions. Reducing biopsy threshold may augment the risk of over diagnosis and over treatment mainly without the capability to differentiate indolent from aggressive cancers.
These findings were published in the July 26 issue of Archives of Internal Medicine.