Treatment of Prostate Cancer with Low PSA Value

After the introduction of PSA test, many more prostate cancers are discovered, most of which are not invasive, so survival at 5 years in these subjects approaches 100%. For this reason, researchers have considered the problem of overdiagnosis and consequent excessive treatment. In order to study the matter in depth, the data from a national database concerning about 124,000 patients affected by prostate cancer between 2004 and 2006 have been used and it was seen that 14% of subjects presented PSA values < 4.0 ng/ml; among these ones, a little more than half of them had a low-risk cancer type (stage < T2a with a Gleason score < 6). Among all subjects with PSA < 4.0 ng/ml, 44% was treated with radical prostatectomy and 33% with radiation therapy. The probability to receive an aggressive treatment increased in the same way as staging or Gleason score increased, but not according to the increase in PSA value (so, aggressive treatments have also been given with a low PSA value).

According to a European trial on PSA screening, 48 people must be treated to prevent a prostate-cancer-related death, while, in a Scandinavian trial, radical prostatectomy showed not to be better than the watchful waiting in older subjects with a low-invasiveness cancer. The problem of overdiagnosis and of PSA screening is more and more urgent and important, above all as to the treatment of subjects with low PSA values (lower than 10 ng/ml), above all if associated with a cancer stage < 2Ta and a Gleason score < 6.