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?

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.