PSA Levels Before Age 70 Strongly Predict Prostate Cancer Mortality

Key Clinical Summary

• Population: 921 609 male veterans aged 70 years with prior prostate-specific antigen (PSA) screening (2008–2020).
• Finding: PSA values from ages 65 to 69 were the strongest predictors of 10-year prostate cancer–specific mortality (PCSM) and metastatic disease, regardless of race or comorbidity.
• Implication: Men with PSA < 1 ng/mL before age 70 had extremely low long-term risk, suggesting limited value in continued screening.

A large cohort study published in JAMA Network Open used Veterans Health Administration data to evaluate whether PSA levels, race, and competing mortality risk predict PCSM and metastatic prostate cancer (mPCa) after age 70. The findings suggest that PSA history before age 70 provides powerful prognostic information and may guide decisions about when to discontinue screening in older men.

Study Findings

Researchers analyzed data from 921 609 veterans who turned 70 between 2008 and 2020 and had a prior PSA < 4 ng/mL at ages 65 to 69. The cohort was 82% White, 11% Black, and 5% Hispanic. Nearly 87% continued PSA screening after age 70, regardless of health status or race.

Over 10 years, the cumulative incidence of PCSM was 0.26% overall, with 95% of men showing risk < 0.73%. PSA levels were strongly predictive of outcomes:

• PCSM 0.10% for PSA 0.20–0.99 ng/mL vs 0.79% for PSA 3.00–3.99 ng/mL.
• mPCa 0.13% for PSA 0.20–0.99 ng/mL vs 1.37% for PSA 3.00–3.99 ng/mL.

Even among the healthiest Black men, a PSA < 1 ng/mL identified an exceptionally low-risk group (10-year PCSM 0.08%; mPCa 0.24%). Conversely, men with higher baseline PSA values showed increased risks but remained under 1% for PCSM at 10 years.

Despite these findings, screening continued broadly—indicating possible overtreatment and unnecessary biopsies in low-risk groups.

Clinical Implications

These results highlight the prognostic value of PSA history before age 70 in determining future prostate cancer risk. A PSA < 1 ng/mL may reliably define a “very-low-risk” subgroup across all racial groups, supporting cessation of PSA screening in these men.

Current practice patterns—where most men continue testing beyond age 70—may expose patients to overdiagnosis, anxiety, and procedural harm without measurable mortality benefit. Conversely, older men with higher PSA values could warrant individualized decisions about ongoing screening, particularly if healthy with longer life expectancy.

The study supports a personalized, risk-adapted approach to screening based on PSA results obtained before age 70 rather than on age alone, aligning with shared decision-making guidelines.

Conclusion

In one of the largest US veteran cohorts to date, PSA levels measured before age 70 were the key determinant of future prostate cancer mortality and metastasis. The study suggests that continued PSA screening after age 70 offers little benefit for men with low prior PSA values, regardless of race or comorbidity.

Reference

Chung DH, Caverly TJ, Schipper MJ, et al. Prostate cancer mortality in men aged 70 years who recently underwent prostate-specific antigen screening. JAMA Netw Open. 2025;8;(2):e2459766. doi:10.1001/jamanetworkopen.2024.59766