Original articles

Should baseline PSA testing be performed in men aged 40 to detect those aged 50 or less who are at risk of aggressive prostate cancer?

C F Heyns, M Fisher, A Lecuona, A van der Merwe

Abstract


Objective. We aimed to evaluate the presenting features and treatment outcome of prostate cancer in men aged <50 years, in a region where prostate specific antigen (PSA) screening is not readily available and most men present with symptoms.
Methods. We analysed the data of 1 571 men with prostatic adenocarcinoma treated between January 1997 and December 2008 at our institution, a tertiary level public sector hospital serving a largely indigent population. Statistical analysis was performed using Student’s, the Mann-Whitney and Fisher’s exact tests where appropriate (p<0.05 accepted as statistically significant).
Results. Of 1 571 men, 47 (3%) were aged <50 years. The group aged <50 years, compared with that aged >50 years, had a significantly greater proportion with poorly differentiated adenocarcinoma (53%), locally advanced (stage T3 - 4) tumours (56%), haematogenous metastases (75%), significantly higher serum PSA at diagnosis (mean 621, median 74 ng/ml) and shorter survival.
Conclusions. Men aged <50 years presenting with symptoms owing to prostate cancer had significantly higher-risk disease, higher mean PSA, and poorer prognosis than men aged >50 years. To diagnose prostate cancer at a potentially curable stage in men aged <50 years, it is necessary to initiate baseline PSA testing at age 40 and 45 years, and to select high-risk men for PSA surveillance in order to diagnose potentially curable cancer in those with a life expectancy >20 - 25 years.

Authors' affiliations

C F Heyns, Department of Urology, Stellenbosch University and Tygerberg Hospital

M Fisher, Department of Urology, Stellenbosch University and Tygerberg Hospital

A Lecuona, Department of Urology, Stellenbosch University and Tygerberg Hospital

A van der Merwe, Department of Urology, Stellenbosch University and Tygerberg Hospital

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Keywords

Prostate; Carcinoma; PSA; Screening; Age

Cite this article

South African Medical Journal 2011;101(9):642-644.

Article History

Date submitted: 2010-11-29
Date published: 2011-09-05

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