Objective
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.
Results
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%).
Conclusion
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Onoclogy. Prostate Cancer Early Detection, version 2.2012. Available at: http://www.nccn.org/professionals/physician_gls/pdf/prostate_detection.pdf. Accessed March 27, 2013.
- Screening for prostate cancer.CA Cancer J Clin. 2009; 59: 264-273
- Introducing the 2010 American Cancer Society prostate cancer screening guideline.CA Cancer J Clin. 2010; 60: 68-69
Carter HB, Albertsen P, Barry MJ, et al. American Urological Association. Early detection of prostate Cancer: AUA guideline. Available at: http://www.auanet.org/common/pdf/education/clinical-guidance/Prostate-Cancer-Detection.pdf. Accessed May 31, 2013.
- Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force.Ann Intern Med. 2011;
- Prostate-cancer mortality at 11 years of follow-up.N Engl J Med. 2012; 366: 981-990
- Measuring mortality reductions in cancer screening trials.Epidemiol Rev. 2011; 33: 36-45
- Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up.J Natl Cancer Inst. 2012; 104: 125-132
- Prostate-specific antigen as predictor of prostate cancer in black men and white men.J Natl Cancer Inst. 1995; 87: 354-360
- Screening and prostate-cancer mortality in a randomized European study.N Engl J Med. 2009; 360: 1320-1328
- Low levels of prostate-specific antigen predict long-term risk of prostate cancer: results from the Baltimore Longitudinal Study of Aging.Urology. 2001; 58: 411-416
- Baseline prostate-specific antigen compared with median prostate-specific antigen for age group as predictor of prostate cancer risk in men younger than 60 years old.Urology. 2006; 67: 316-320
- Prostate-specific antigen at or before age 50 as a predictor of advanced prostate cancer diagnosed up to 25 years later: A case-control study.BMC Medicine. 2008; 6: 6-14
- Prostate specific antigen levels in young adulthood predict prostate cancer risk: results from a cohort of black and white Americans.J Urol. 2005; 174: 872-876
- Prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate-specific antigen at or before age 50.Cancer. 2011; 117: 1210-1219
- Long-term prediction of prostate cancer up to 25 years before diagnosis of prostate cancer using prostate kallikreins measured at age 44 to 50 years.J Clin Oncol. 2007; 25: 431-436
- Serum prostate-specific antigen in a community-based population of healthy men: Establishment of age-specific reference ranges.JAMA. 1993; 270: 860-864
- Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening: 1986-2005.J Natl Cancer Inst. 2009; 101: 1325-1329
- Is additional testing necessary in men with prostate-specific antigen levels of 1.0 ng/mL or less in a population-based screening setting? (ERSPC, section Rotterdam).Urology. 2005; 65: 343-346
- Prostate Specific Antigen Best Practice Statement: 2009 Update.J Urol. 2009; 182: 2232-2241
- Radical prostatectomy versus watchful waiting in early prostate cancer.N Engl J Med. 2011; 364: 1708-1717
- Radical prostatectomy versus observation for localized prostate cancer.N Engl J Med. 2012; 367: 203-213
- We need a better marker for prostate cancer. How about renaming PSA?.Urology. 2011;
- Mortality results from a randomized prostate-cancer screening trial.N Engl J Med. 2009; 360: 1310-1319
- Prostate cancer: clinical practice guidelines in oncology™.J Natl Compr Canc Netw. 2010; 8: 162-200
Surveillance Epidemiology and End Results. Prostate Cancer SEER Incidence and U.S. Death Rates, Age-Adjusted and Age-Specific Rates, by Race. Available at: http://seer.cancer.gov/csr/1975_2009_pops09/browse_csr.php?section=23&page=sect_23_table.07.html. Accessed November 5, 2012.
- Predicting prostate cancer many years before diagnosis: how and why?.World J Urol. 2011; 30: 131-135
Article info
Publication history
Published online: October 21, 2013
Accepted:
June 21,
2013
Received:
March 27,
2013
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This project was supported by research grants from the Public Health Service, National Institutes of Health (DK58859, AR30582, and 1UL1 RR024150-01), and Merck Research Laboratories.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial CommentUrologyVol. 82Issue 6
- PreviewIn 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.
- Full-Text
- Preview
