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Predicting Prostate Cancer Death

Rapid Rise in PSA Levels Even Years Before Diagnosis May Foretell Outcome
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WebMD Health News
Reviewed by Louise Chang, MD

Oct. 31, 2006 -- Men with prostate cancer don't always need treatment, but there is no reliable way to tell which cancers are deadly and which are not.

Now, new research suggests a blood test widely used to screen for the disease can identify which patients are more likely to die from it -- and do so more than a decade before the cancercancer is even diagnosed.

In the study, Johns Hopkins School of Medicine researchers report that the rate at which prostate specific antigen (PSA) levels change over time is an accurate predictor of prostate cancer survival 25 years later.

They found that 92% of patients with a slower rise in PSA levels a decade or so prior to diagnosis were alive 25 years later. Meanwhile, only 54% of those with higher rises in PSA survived their disease 25 years later.

The PSA test measures blood levels of a protein made by the prostate. As prostate cancer cells increase in number, PSA levels can rise.

In the study, the rate of PSA rise, known as PSA velocity, was assessed among men who ended up dying of prostate cancer and those who had the disease but were still living.

The researchers found that PSA velocity 10 to 15 years before the cancer was diagnosed was a strong predictor of whether men lived or died decades later.

"It is absolutely amazing that a blood test can tell with relative accuracy who will die of prostate cancer and who will not years before diagnosis," researcher H. Ballentine Carter, MD, tells WebMD.

Controversial Test

The PSA has become controversial as a screening tool, with critics charging it has led to the overdiagnosis and treatment of cancers that would have never affected the patient's life.

"Right now, 94% of men with a diagnosis of prostate cancerprostate cancer undergo active treatment, regardless of age," Carter says. "We are overdiagnosing and overtreating this disease, and part of my interest is to try and make an impact on that."

In the past, PSA levels of less than 4.0 ng/mL (nanograms of protein per milliliter of blood) have been considered normal, with any PSA number above that seen as suspicious.

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