Finally, someone has presented a common sense approach for using the Prostate Specific Antigen (PSA) blood test. Long criticized for causing “over diagnosis and unnecessary biopsies,” the reference I cite says “a single PSA measurement in men aged 45-70 years effectively identified individuals with low risk for cancer.” This is good news that will reduce the number of unnecessary biopsies and give millions peace of mind.
The study was done in Berlin, Germany from October 1997 to September 2021. The 2651 men aged 45-70 were to be followed for 20 years. The median age at onset of observation was 54.0 years, and the median follow-up was 10.8 years. So these men had a baseline PSA then were observed for up to 20 years to see if prostate cancer developed.
What was found was the probability of developing prostate cancer based on the PSA level determined at the beginning of the study. As mentioned, the men’s age range was 45-70 with the mean (middle) age being 54.0. These men were all in a “middle age” range. The results were very interesting and very positive for middle-aged men with low PSA’s. First I will share the percentages of men in each PSA range. The results follow:
55.9% of men studied had a PSA of 1.0 or less
36.1% of men studied had a PSA of 1.0-3.0
8% of men studied had a PSA of greater than 3.0
Over half of these study participants had a low PSA. That’s good!
When it came to incidence of prostate cancer based on what their PSA had been 20 years earlier, the following results were found:
After 20 years of observation:
If the baseline PSA was less than 1.0, only 3.3% developed prostate cancer (PCA)
If the baseline PSA was 1.0 to 3.0, there was an 11.8% chance of PCA
If the baseline PSA was greater than 3.0, there was a 34.8% chance of PCA
CONCLUSION: The study found that a low mid-life baseline PSA was associated with a low long term risk of prostate cancer.
An initial mid-life PSA level will help patients know their chances of developing PCA. It will tell you how frequently you need to have a PSA done and help to lessen the number of “unnecessary investigations.”
It seems like a lot to rely on one single blood test at middle age to dictate the entire course followed by patients to detect prostate cancer. However, the fact that PCA is slow growing, reassures us were not being blasé about the seriousness of PCA. Men do still die from PCA. This data will definitely reduce the frequency of PSA testing and frequency of prostate biopsies. I think that’s the purpose of this study. So, if you’re 50 years old and your PSA is 0.75 (<1.0), you have a 96.7% chance of never having PCA. But if it’s 4.5 (>3.0) you better get used to being stuck, probed, and biopsied, because there’s over a one-third chance you’ll develop prostate cancer.
I think this is very good information and will help to lessen the anxiety men feel when that “annual” PSA test is due. I also know the peace I would feel if my personal PSA was less than 1.0. So check with your doctor and follow his/her advice being certain to share the results supplied, here.
Reference: Mukherjee G. Midlife PSA Predicts Long Term Risk for Prostate Cancer. Medscape 2026 February 6.
