This may allow true advances in the development of new markers of malignant potential. Haese and colleagues11 examined the TMPRSS2-ERG gene fusion and its relationship to pathology at radical prostatectomy. They used a urine assay to quantitate the TMPRSS2- ERG fusion. Among 74 men, 38% had non-organ-confined disease and 93% had Gleason score ≥ 7. The gene fusion level was significantly higher in men with non-organ-confined disease and those with Gleason score 7 versus 6. [Michael K. Brawer, MD] Prostate Cancer Prostate cancer screening was a major theme at Inhibitors,research,lifescience,medical the 2011 AUA meeting. There

is now randomized evidence that PSA screening reduces prostate cancer mortality for men aged 50 to 69 years.12,13 However, prior studies have suggested high rates of screening in elderly men with limited life expectancies who are unlikely to benefit.14 A new report from Gupta and colleagues examined rates of PSA screening in men from the Behavioral Risk Factor Surveillance System survey Inhibitors,research,lifescience,medical (2001–2008).15 Inhibitors,research,lifescience,medical They found that men in their 70s were more likely to undergo screening than men aged 40 to 60 years, and that approximately 60% of men aged ≥ 80 years had a PSA test in the past year. These results suggest continued overutilization of screening in elderly men, as well as potential underutilization of baseline

PSA testing at a younger age. Indeed, prior studies have shown that PSA levels at a young age are associated with

the risk of prostate cancer and aggressive disease.16,17 Vickers and colleagues presented new data from the Malmo Preventive Project in Sweden, in which a Inhibitors,research,lifescience,medical single PSA measurement at age 44 to 50 years predicted disease-specific mortality at a median follow-up of 27 years.1 In this study, 44% of all later prostate cancer deaths occurred in men with PSA levels in the top 10% at age 44 to 50 Inhibitors,research,lifescience,medical (> 1.5 ng/mL), PDK1 cancer indicating a high-risk population for whom careful follow-up is necessary. Another controversy is the appropriate age to discontinue screening. One recent study suggested that men with a PSA level < 1 ng/mL at age 60 years do Physiological Reviews not require further PSA testing given the low risk of metastasis and death in this patient subset.18 In a new analysis from the Baltimore Longitudinal Study of Aging, Loeb and Colleagues19 similarly reported a low overall risk of prostate cancer (6.5%) among men with an initial PSA < 1 ng/ mL in their 60s; however, 30.8% of these cases were life threatening. Moreover, despite starting out with a PSA<1 ng/mL, the subsequent PSA trajectory differed substantially between men without prostate cancer compared with those later diagnosed with non-high-risk and, particularly, high-risk disease. Thus, additional PSA measurements would have identified high-risk cases. However, the optimal number and timing of additional PSA screening require further study.

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