Volume 200 - Issue 10
Liaise with pathologists to refine understanding of the prostate-specific antigen test
Author: Kenneth A Sikaris
Med J Aust 2014; 200 (10): 578. || doi: 10.5694/mja14.00048
Published online: 2 June 2014
Published online: 2 June 2014
Age-related medians significantly predict prostate cancer outcomes
In reply: It is interesting that in the debate on prostate cancer screening, positions are not as far apart as a “debate” implies. I agree with Del Mar and colleagues that all the existing trials have “serious potential methodological flaws” and therefore cannot be taken as evidence that prostate-specific antigen (PSA) screening is effective — nor that it is ineffective. Both sides of the “debate” are consistent with the recent National Health and Medical Research Council conclusion that PSA testing may help some men and may not help others.
Numerous studies have shown that age-related medians significantly predict prostate cancer outcomes,1-5 and therefore the experts advising the Medicare Benefits Schedule have supported follow-up of PSA levels above the median. While I am also hopeful that new markers for detection will be found, in the interim, in the realm of pathology testing, no better approach than PSA-based testing is available. While magnetic resonance imaging may offer significant advantages (and at a cost), I would leave this potential for my medical imaging and urology colleagues to sort out, as it is outside my area of expertise.
Competing interests
No relevant disclosures.
References
- Loeb S, Roehl KA, Antenor JA, et al. Baseline prostate-specific antigen compared with median prostate-specific antigen for age group as predictor of prostate cancer risk in men younger than 60 years old. Urology 2006; 67: 316-320. 1
- Vickers AJ, Cronin AM, Björk T, et al. Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: case-control study. BMJ 2010; 341: c4521. 2
- Lilja H, Cronin AM, Dahlin A, et al. Prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate-specific antigen at or before age 50. Cancer 2011; 117: 1210-1219. 3
- Bul M, van Leeuwen PJ, Zhu X, et al. Prostate cancer incidence and disease-specific survival of men with initial prostate-specific antigen less than 3.0 ng/ml who are participating in ERSPC Rotterdam. Eur Urol 2011; 59: 498-505. 4
- Vickers AJ, Ulmert D, Sjoberg DD, et al. Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study. BMJ 2013; 346: f2023. doi: 10.1136/bmj.f2023. lefthere