What a Single PSA Level at Midlife Can Tell You

At this year’s American Urological Association meeting a scientist from Memorial Sloan Kettering Cancer Center presented some surprising findings. Lilja described the follow-up of men who had a PSA determination in their 40s – the actual data came from archived blood samples collected from over 21,000 men in Sweden.

Almost 500 cases of prostate cancer had been diagnosed 17 years, on average, after a midlife PSA determination. 161 of these cases were advanced. The investigators compared the patients with advanced cancer to a group of 436 men from the same population, but without prostate cancer. The average free and total PSA levels for those with advanced prostate cancer were 0.35 and 1.22 ng/mL, respectively, while those of the controls were 0.18 and 0.54, respectively. Overall, 60% of the men whose midlife PSA levels were in the top one-fifth developed advanced prostate cancer (e.g. evidence of skeletal metastases) within 25 years.

There are caveats, of course. The samples were from Sweden , and just might be unrepresentative for USA men. “Further studies are needed.” But it seems that one should now start PSA screening in t he 40s, and focus our subsequent attention on the men with the highest levels, making sure that they get annual screening. Men with lower midlife PSA levels may not require such intensive screening.