by Jared Reed  

Men in their mid-forties should start having PSA tests for prostate cancer, as their younger age means results are unlikely to be confused with higher PSA levels seen in older men developing an enlarged prostate, Australian and US urologists say.  

They point to a 2007 Swedish study of 21,000 men aged under 50 which found that early PSA testing reliably predicted the development of prostate cancer up to 25 years after the test.  

“There may be a way of eliminating the effect of transition-zone PSA by a baseline testing of all men before the development of benign prostatic hyperplasia, that is, while men are in their mid-forties,” they write in the British Journal of Urology International (104: 11; 1553-54).  

“Could we not therefore use a single PSA test as a predictor for the long-term risk of prostate cancer in younger men around the age of 45 years?” says lead author and urologist Dr Ben Challacombe from the Royal Melbourne Hospital.  

His calls are backed by the Urological Society of Australia and New Zealand, which in its latest position statement says PSA testing should be offered to 40-year-old men in conjunction with a digital rectal examination.   

However a recent major US study showed no benefit of prostate cancer screening after up to ten years of follow up in men offered PSA testing and digital rectal examination. Another European study found a 20% relative reduction in prostate cancer mortality in men offered PSA screening, but this was associated with a high rate of overdiagnosis.