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Predicting Prostate Cancer Death

Rapid Rise in PSA Levels Even Years Before Diagnosis May Foretell Outcome
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Controversial Test continued...

But it is now known that men with PSA levels under 4.0 can have prostate cancercancer; and it is increasingly clear that a single PSA reading usually doesn't tell the whole story, Carter says.

"There is no single PSA level that can be used to determine if someone needs a biopsy," he says.

A better approach, Carter says, is to test PSA at regular intervals to determine how fast levels are rising.

He suggests men have a baseline PSA at age 40, with the timing of repeat tests determined by that PSA and other risk factors.

In the Johns Hopkins study, men with a PSA velocity above 0.35 per year – meaning their PSA level rose more than that per year -- were five times more likely to die of prostate cancer 25 years later than men with a slower rise in PSA.

The study is published in the Nov. 1 issue of the Journal of the National Cancer Institute.

Prognostic Potential

The hope is that if used in this new way, PSA testing will help doctors better distinguish between men with prostate cancer who will die without treatment and those who will not.

Prostate cancer researcher Timothy R. Church, PhD, says larger studies under way will help determine if PSA velocity can help predict prognosis.

Until the results of those studies are known, generalized guidelines regarding PSA screening are not possible, Church says.

"At this point it really comes down to a conversation between the patient and his medical care provider," Carter tells WebMD. "It is not a simple decision."

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