Landmark study by Apollo Hospitals redefines prostate cancer detection in India

The study found that Western standards for Prostate-specific Antigen (PSA) levels are ill-suited for Indian men and it put forth new standards.

ByChetana Belagere

Published Jan 13, 2024 | 3:00 PMUpdatedJan 13, 2024 | 3:00 PM

New prostate cancer study by Apollo Hospitals. (Wikimedia Commons)

Prostate cancer in India is rapidly escalating, but recent groundbreaking research from Apollo Hospitals is poised to redefine its diagnosis and treatment strategies.

Apollo Hospitals has conducted a large study in India to better understand how to detect prostate cancer in Indian men and have come up with new prostate-specific-antigen (PSA) levels, a key blood marker for prostate cancer. They have established new reference values for PSA that is specific to the Indian demographic.

Led by Dr N Ragavan and Dr Sanjai Addla from Apollo Chennai and Apollo Hyderabad, respectively, the study engaged nearly 1,00,000 healthy men spanning diverse age groups and regions in India. A significant revelation emerged — the PSA levels indicative of prostate cancer in Indian men differ significantly from those established in Western populations.

This discovery, documented in the Indian Journal of Urology, is anticipated to pave the way for more precise and early detection of prostate cancer in Indian men. The ultimate goal is to develop more effective treatment strategies tailored to the unique characteristics of the Indian demographic.

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Prostate cancer

Prostate cancer is a type of cancer that occurs in the prostate gland, which is part of the male reproductive system. This gland is responsible for producing seminal fluid, which nourishes and transports sperm.

Prostate cancer, according to doctors, has recently become the second-most common cancer in urban India, overtaking its previous ranking at fourth place. Recently, Maestro Rashid Khan died due to prostate cancer.

Dr Raghunath SK from the HCG Cancer Hospital in Bengaluru, had earlier told South First, that prostate cancer is uniquely prevalent in urban areas, attributing its rise to factors like lifestyle, food habits, stress, pollution, lack of exercise, and exposure to chemicals.

He emphasised the significance of early diagnosis and noted that age and family history also play roles in increasing risk. The disease’s urban predominance and growing incidence underscore the need for heightened awareness and screening efforts, he had said.

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Indianising PSA values

According to researchers, since 1993, international norms for normal PSA values have been based on a study from the USA and the same reference values have been adopted in India. However, the Western standards have quite often been found to be ill-suited for the Indian population, due to diverse genetic demarcations.

The researchers from Apollo Hospitals looked at the levels of PSA and found that the normal levels for Indian men are different from the reference levels used in Western countries.

This means that using these new levels, specific to Indian men, doctors can more accurately detect prostate cancer early, even in younger men, which is important for effective treatment.

With this, Apollo Hospitals, clinics, and the diagnostics network will move towards the adoption of new PSA standards for prostate screening, said the researchers.

Study findings

The study, “Determining age-specific prostate-specific antigen for healthy Indian men”, analysed the hospital database of men who underwent PSA blood tests at two tertiary referral centres in South India between January 2011 and August 2018.

Out of 99,386 men who underwent these tests, 86,728 were further analysed after excluding non-Indian patients and those with extreme PSA levels.

Click to enlarge.

Click to enlarge.

A key finding was that 70 percent of the patients were below 60 years of age and the mean PSA was 1.2 ng/mL. The study established the 95th percentile serum PSA levels for various age groups, which increased with each decade of life.

This research indicates a positive correlation between serum PSA level and age in Indian men, and these values are lower than those defined for Caucasian men. The results provide a new basis for establishing age-specific reference ranges of PSA for Indian men, which can enhance clinical decision-making.

Dr Sangita Reddy, Joint Managing Director, Apollo Hospitals told the media, “Establishing new prostate cancer screening standards for Indian men across ages in a landmark study reflects our commitment to pioneering advancements that redefine cancer care. With divergent PSA standards for different age groups, a progressive increase in levels with age, and Indian-specific values, we are transforming the landscape of prostate cancer care. This monumental shift not only facilitates earlier detection in younger men but also prevents unnecessary investigations in older individuals,” she said.

Also Read: Cancer mortality sees increase in women but declines in men

New screening standard 

The previous standards often proved inadequate for the Indian population, leading to misdiagnosis or delayed detection, primarily due to genetic differences.

The study revealed a progressive increase in PSA levels with age: <1.4 ng/mL (<40) to 11.3 ng/mL (>80).

The study has established different PSA levels for various age groups specific to the Indian demographic, ensuring more accurate and early detection.

With age-specific standards, the risk of unnecessary investigations in older men is significantly reduced, while still ensuring that younger men are screened effectively.

Speaking on the study, Professor Sanjai Addla of Apollo Hospitals, said that this offers a more effective diagnostic tool and the potential for better treatment outcomes, even in advanced stages.

“This study is crucial as it addresses the gap in data regarding age-specific PSA levels for the Indian population, contrasting with the standards used for Caucasian men, and paves the way for more precise clinical decisions in combating prostate cancer in India,” he said.