Discovery Winter 2019
November 3, 2018

“Given the higher prevalence of hepatitis C virus in Baby Boomers and rising prevalence of non- alcoholic fatty liver disease, our work has implications for prostate cancer screening.”

If you have liver problems, your PSA may not be as low as you think it is.

That’s the message from a new Hopkins study led by master’s student Anqi Wang and her advisor, epidemiologist Elizabeth Platz, Sc.D., M.P.H., with Mariana Lazo, M.D., Ph.D., Sc.D., H. Ballentine Carter, M.D., John Groopman, Ph.D., and William G. Nelson, M.D., Ph.D.

Previous studies had observed that men who have liver cirrhosis also have lower PSA levels, notes Platz. Could other liver conditions influence PSA as well? To find out, Wang, Platz and colleagues looked at PSA levels in nearly 7,000 men age 40 and older, and determined who likely had and did not have liver fibrosis – scar tissue in the liver, which develops as the liver attempts to fix cells damaged by disease. They used data from the National Health and Nutrition Examination Survey (NHANES). “We took into account age, race, ethnicity, body mass index, diabetes status, alcohol drinking, and smoking.”

In all the men, the investigators found, the presence of liver fibrosis was associated with lower PSA than in men without liver fibrosis – the more severe the fibrosis, the lower the PSA. “Men with an abnormal fibrosis score had a substantially lower odds of having a PSA over 4 ng/ml compared to men without fibrosis,” says Wang, and this was consistent despite race or ethnicity.

“Given the higher prevalence of hepatitis C virus in Baby Boomers and rising prevalence of non-alcoholic fatty liver disease, both of which can lead to liver fibrosis, our work has implications for prostate cancer screening,” Wang continues. “Men with higher liver fibrosis scores (more likely to have more severe liver fibrosis) had lower PSAs, and men with abnormal fibrosis scores had a lower odds of having an elevated PSA.”

The study raises the concern that men with these liver conditions may be less likely to have prostate cancer detected. “The risk and benefits of prostate cancer screening for men with liver fibrosis and liver disease should be considered in decision-making,” says Platz. Her advice for men in this situation: “Talk to your doctor if you have a liver disease about how it might affect the PSA test. And, if you are a Baby Boomer (born 1945-1965), consider a one-time check for hepatitis C virus infection.”