Weight CJ, et al. – The physicians conducted this work to assess population–based prostate cancer (CaP) testing of men in their 40s, given the paucity of prospective data evaluating the consequences of PSA testing in younger men for prostate cancer (CaP). CaP testing in men beginning at age 40 resulted in a significant increase in the risk of prostate biopsy (PBx) and diagnosis of low risk CaP, without a measurable reduction in risk of CaP–death in this low risk population. However, given the natural history of CaP, a longer follow–up is needed to confirm this finding.

Methods

• 1052 men in their 40s were followed longitudinally for prostate outcomes, from 1990 to 2010.
• A random subset of 268 men was selected to undergo biennial CaP testing including: PSA testing, transrectal ultrasound, and a digital rectal exam (DRE).
• They also evaluated a representative population of 609 men with a subset of 159 men who also began CaP testing in their 50s as a comparison group.
• They compared risks of prostate biopsy (PBx), CaP, or death from CaP between CaP tested and the routine care population cohort.

Results

• In this study, 17.2 years was the median follow–up.
• The obtained data indicate that men aged 40–49, who underwent CaP testing were 2.4x more likely to undergo a PBx (HR 2.4 95% CI: 1.8–3.3) and 2.2x more likely to be diagnosed with low risk CaP (HR 2.2, 95% CI: 1.12–4.0).
• On the other hand, those initiating CaP testing a decade earlier were 2.2x and 1.7x more likely to be biopsied and be diagnosed with CaP for any given age (HR 2.2 95% CI 1.4–3.5 and 1.7 95% CI 1.1–2.7, respectively).