Ambulatory and Office Urology| Volume 82, ISSUE 6, P1211-1219, December 2013

Men (Aged 40-49 Years) With a Single Baseline Prostate-specific Antigen Below 1.0 ng/mL Have a Very Low Long-term Risk of Prostate Cancer: Results From a Prospectively Screened Population Cohort

Published:October 21, 2013DOI:


      To study the use of a baseline prostate-specific antigen (PSA) and digital rectal examination in men (aged 40-49 years) in predicting long-term prostate cancer risk in a prospectively followed, representative population cohort.

      Patients and Methods

      Since 1990, a random sample of men in Olmsted County (aged 40-49 years) has been followed up prospectively (n = 268), with biennial visits, including a urologic questionnaire, PSA screening, and physical examination. The ensuing risk of prostate cancer (CaP) was compared using survival analyses.


      Median follow-up was 16.3 years (interquartile range 14.0-17.3, max 19.1). For men with a baseline PSA <1.0 ng/mL (n = 195), the risk of subsequent Gleason 6 CaP diagnosis by 55 years was 0.6% (95% confidence interval [CI] 0%-1.7%) and 15.7% (95% CI 6.5%-24.9%) for men with a baseline PSA ≥1.0 ng/mL. No man with a low baseline PSA developed an intermediate or high risk CaP, whereas 2.6% of men with a higher baseline PSA did (95% CI 0.58%-4.6%).


      Men (aged 40-49 years) can be stratified with a baseline PSA. If it is below 1.0 ng/mL, there is very little risk for developing a lethal CaP, and as many as 75% of men might be able to avoid additional PSA screening until 55 years. Conversely, men aged 40-49 years with a baseline PSA level >1.0 ng/mL had a significant risk of CaP diagnosis and should be monitored more closely.
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      Linked Article

      • Editorial Comment
        UrologyVol. 82Issue 6
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          In recent years, new prostate-specific antigen (PSA) testing guidelines from various professional organizations have sparked controversy, as there is a divergence of opinions on the usefulness of PSA. Panels formulating these guidelines rely heavily on randomized clinical trials and statistical modeling studies of trial data, whereas frequently ignoring compelling evidence from other sources. In addition, independent panels have formulated widely varying recommendations from the same body of evidence.
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