Doctors Urge Baseline Test for Prostate Cancer

New studies at the urology meeting suggest ways. One found that a man's PSA at age 60 can strongly predict whether he ultimately will die of the disease.

Dr. Hans Lilja of Memorial Sloan-Kettering Cancer Center in New York tested stored blood samples from nearly 1,200 Swedish men from the early 1980s and checked cancer registries to see how many later developed or died of prostate cancer.

If PSA was 1 or less at age 60, the risk of dying of prostate cancer by age 85 was very low -- less than 1 percent -- even if men had the disease for many years. About 90 percent of cancer deaths occurred in men whose PSAs at age 60 were in the top one-fourth of the group.

In a different study, Dr. E. David Crawford of the University of Colorado Health Sciences Center studied 29,000 men from one of the large screening studies reported last month. Only about 1 percent of those whose initial PSA test was under 1 saw their scores rise above 4 in the next five years. Those with higher baseline scores had a much greater chance of that happening.

"The bottom line is if you've got a PSA of less than one in your initial screen, you can wait to get another PSA for five years and not really be at increased risk of missing a cancer," he said. "If your PSA is between 1 and 2, it's also a small risk."

Crawford is the unpaid chairman of the Prostate Conditions Education Council, an industry-supported group that promotes screening.

Dr. Robert Uzzo, a prostate surgeon at Fox Chase Cancer Center in Philadelphia, said many doctors are already advising longer testing intervals.

"Everybody has to get screened at least at some baseline" to sort out future testing needs, he said. "If the baseline is quite low then I don't insist on yearly screening."

Dr. Otis Brawley, the American Cancer Society's chief medical officer, believes there is still some value to PSA testing, but added: "I am very concerned that the urology community and the American public may think there's more value in PSA than there actually is."