Nikhil Prasad Fact checked by:Thailand Medical News Team Feb 01, 2026 1 hour, 30 minutes ago
Medical News: In a surprising development that could reshape how prostate cancer risk is viewed, new research has found that men diagnosed with prostate cancer based solely on very high PSA levels may actually have much better outcomes than previously believed. PSA, or prostate specific antigen, has long been used as a key marker to classify prostate cancer as high risk, especially when levels exceed 20 ng/mL. However, this new evidence suggests that PSA alone may not tell the full story.
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New research shows that men with prostate cancer marked only by high PSA levels often respond extremely well
to modern radiation treatment.
Rethinking High Risk Prostate Cancer
Traditionally, prostate cancer is classified as high risk if a patient meets any one of three criteria: a PSA level above 20 ng/mL, aggressive cancer cell patterns known as high Gleason scores, or evidence that the tumor has grown beyond the prostate. Doctors have typically treated all these patients aggressively, often with long courses of hormone therapy combined with radiation.
This
Medical News report is based on a detailed analysis led by researchers from the Department of Radiation Oncology at Cedars Sinai Medical Center in Los Angeles and the Department of Radiation and Cellular Oncology at the University of Chicago Medical Center. The researchers examined outcomes in 742 men treated with modern radiation therapy over a 16-year period.
How the Study Was Conducted
Among the men studied, 282 met the standard definition for high-risk prostate cancer. Importantly, 49 of these men had only one high risk feature: a PSA level above 20 ng/mL. They did not have aggressive tumor grades or advanced local disease. Most patients received high dose radiation therapy, and nearly all were also treated with hormone blocking therapy, though those with PSA only risk often received shorter hormone treatment.
The researchers tracked two major outcomes: whether PSA levels rose again after treatment, and whether the cancer spread to distant parts of the body.
Key Findings That Challenge Assumptions
The results were striking. Men whose only high-risk factor was PSA above 20 had a 94 percent chance of remaining free from PSA relapse at five years. Even more impressive, 97 percent showed no signs of cancer spread. These outcomes were far better than those seen in other high-risk patients and were similar to results usually seen in intermediate risk prostate cancer.
In contrast, men with high Gleason scores or tumors extending beyond the prostate had significantly worse outcomes. Statistical analysis showed that tumor grade and stage were strong predictors of treatment failure, while PSA level by itself was not.
Why PSA Alone May Be Misleading
Researchers believe that PSA levels can be influenced by factors other than aggressive cancer behavior. Some prostate tumors may produce large amounts of PSA without being especially dangerous. This may cause doctors to o
verestimate risk when PSA is considered alone, leading to more intense treatment than necessary for some men.
Implications for Treatment Decisions
The findings suggest that not all high-risk prostate cancers are the same and that PSA alone may be the weakest high risk indicator. While current guidelines still recommend aggressive treatment for all high-risk patients, the study raises the possibility that selected men with PSA only risk could safely receive less intensive therapy in the future.
Conclusion
This study provides strong evidence that men with prostate cancer classified as high risk solely due to elevated PSA levels may actually have favorable disease biology and excellent treatment outcomes. By showing that PSA alone does not independently predict poor prognosis, the research supports refining risk classification and moving toward more personalized treatment strategies. Future studies with longer follow up and genetic testing will be crucial before changing standard care, but these findings open the door to safer, more tailored approaches for many patients.
The study findings were published in the peer reviewed Journal of Clinical Medicine.
https://www.mdpi.com/2077-0383/15/3/1119
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https://www.thailandmedical.news/articles/cancer
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