Initial PSA tests can’t distinguish lethal prostate cancers

A group of Swedish researchers report that PSA levels measured within two years of a prostate cancer diagnosis provide no indication of which cancers are lethal and which are indolent. This finding increases the challenges faced by men diagnosed with early-stage prostate cancer who are considering active surveillance.

Researchers at the Karolinska Institute analyzed the PSA tests of 267 men undergoing active surveillance as part of a Scandinavian Prostate Cancer Group study, and then tracked eventual health outcomes. They found that neither the initial PSA level nor its rate of increase in a two-year period predicted which men had lethal cancers in need of immediate treatment.

This study underscores the importance of weighing all of your “numbers” at diagnosis, such as Gleason score and clinical stage, as well as other factors such as your family history and overall health. It also points to the importance of finding new blood tests for prostate cancer and advances in other modes of diagnosis.

Source: Fall K, Garmo H, Andren O, et al. Prostate-Specific Antigen Levels as a Predictor of Lethal Prostate Cancer. Journal of the National Cancer Institute 2007;99:526–32. PMID: 17405997.

Originally published April 2009; last reviewed March 21, 2011.