INTRODUCTION: Many guidelines suggest earlier screening for prostate cancer for high-risk men, defined in terms of race and family history.
Recent evidence has suggested that a baseline prostate-specific antigen (PSA) level is strongly predictive of long-term risk of aggressive prostate cancer. We compared the utility of risk-stratifying early screening by race, family history and PSA at age 45.
METHODS: Using estimates from the literature we calculated the proportion of men targeted for early screening using either family history, African-American race or PSA as the criterion for high risk. We calculated the proportion of prostate cancer deaths that would occur in those men by age 75.
RESULTS: Screening based on family history would involve 10% of men accounting for 14% prostate cancer deaths. Using African-American race as a risk criterion would involve 13% of men accounting for 28% deaths. In comparison, 44% of prostate cancer deaths occur in the 10% of men with the highest PSA levels at age 45. In no sensitivity analysis for race and family history did the ratio of risk group size to number of prostate cancer deaths in that risk group approach that of PSA.
DISCUSSION: Basing decisions for early screening on PSA at age 45 gave the best ratio between men screened and potential cancer deaths avoided. Given the lack of evidence that race or family history affects the relationship between PSA and risk, PSA-based risk stratification would likely include any African-Americans or those with a family history destined to experience aggressive disease. Differential screening based on risk should be informed by baseline PSA.
Written by:
Vertosick EA, Poon BY, Vickers AJ. Are you the author?
Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Reference: J Urol. 2014 Mar 15. pii: S0022-5347(14)02946-2.
doi: 10.1016/j.juro.2014.03.032
PubMed Abstract
PMID: 24641912
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