Tag Archives: rectal

PSA level change a poor measure for prostate cancer

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Change in PSA levels over time, known as PSA velocity, is a poor predictor of prostate cancer and may lead to many unnecessary biopsies, according to researchers at Memorial Sloan-Kettering Cancer Center.

Several groups, including the National Cancer Center Network and the American Urological Association, recommend that men with high PSA velocity get a biopsy for prostate cancer, even if there are no other indicators that cancer may exist.

“We have found no evidence to support the recommendation that men with a high PSA velocity should be biopsied in the absence of other indications. Those indicators could be an elevated baseline PSA or a positive digital rectal exam (DRE),” said Andrew Vickers, Associate Attending Research Methodologist in the Department of Epidemiology and Biostatistics and lead author.

“In other words, if a man”s PSA has risen rapidly in recent years, there is no cause for concern if his total PSA level is still low and his clinical exam is normal,” he added.

prostate cancer

Prostate cancer

The researchers studied 5,519 men aged over 55, who were participating in the prostate cancer prevention trial, with no previous prostate cancer diagnosis, normal DRE, and a baseline PSA of 3.0 ng/mL or less.

The study subkects were randomly assigned to finasteride, a drug commonly used to treat enlargement of the prostate gland, or placebo for seven years.


The team focused on men in the placebo group who were followed with yearly PSA tests. After seven years, all men in the study underwent a biopsy.

Based on these tests, the team found no important link between PSA velocity and biopsy outcome, noting that PSA alone was a much better predictor of biopsy outcome than PSA velocity.

“This study should change practice. We have previously published papers determining that PSA naturally varies from month to month and have urged men whose PSA suddenly rises to wait six weeks and repeat the test before agreeing to a needle biopsy,” said Peter T. Scardino, Chair of the Department of Surgery.

“This study provides even stronger evidence that using changes in PSA as a basis for recommendation for biopsy leads to many more unnecessary biopsies and does not help to find the more aggressive cancers that we want to find and treat,” he added.

The study is published online in the Journal of the National Cancer Institute.

HDL cholesterol levels and bowel cancer

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A new research suggests that high levels of ”good” (high density lipoprotein) HDL cholesterol decrease the risk of bowel cancer.

The association is independent of other potentially cancer-inducing markers of inflammation in the blood.

The findings are based on participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

This is tracking the long-term impact of diet on the development of cancer in more than half a million people in 10 European countries, including the UK.

Some 1,200 people who developed bowel and rectal cancers – 779 bowel and 459 rectal cancer – after agreeing to take part in EPIC were matched with another 1,200 participants of the same age, gender, and nationality.

HDL cholesterol

HDL cholesterol

Blood samples taken when they joined the study, and the dietary questionnaires these participants had completed, were compared to see if there were any discernible differences between the two groups.

The analysis showed that those who had the highest levels of HDL cholesterol, and another blood fat, apolipoprotein A, or apoA – a component of HDL cholesterol – had the lowest risk of developing bowel cancer.

Each rise of 16.6 mg/dl in HDL and of 32 mg/dl in apoA reduced the risk of bowel cancer by 22 percent and 18 percent, respectively, after taking account of diet, lifestyle, and weight.

But HDL and apoA levels had no impact on the risk of rectal cancer.


After excluding those who had only been monitored for two years, as they may have already been undergoing cancerous changes when they joined the study, only levels of HDL were associated with a reduction in bowel cancer risk.

The association remained intact, irrespective of other indicators of inflammation, insulin resistance, and oxygen free radicals levels, all of which are associated with the development of cancer.

The authors explain that low HDL levels have been linked to higher levels of proteins involved in inflammation, while higher levels of proteins that dampen down the inflammatory response have also been linked to high HDL levels.

The pro inflammatory proteins boost cell growth and proliferation while curbing cell death, so HDL may alter the inflammatory process in some way, they suggest.

The study has been published online in Gut.