PURPOSE: Prostate-specific antigen (PSA) screening is controversial, as a large number of men must be screened annually to achieve a benefit.
We sought to determine if baseline PSA could reliably predict subsequent risk of prostate cancer (PCA) and risk of consequential PCA.
MATERIALS AND METHODS: A multi-ethnic cohort of 2923 PCA-free men, were recruited between 2000 and 2012 and followed for a median of 7.5 years Baseline PSA was stratified into 6 strata and relative hazards of PCA detection for each PSA strata were estimated, adjusting for ethnicity, family history, and age.
RESULTS: There were 289 cases of PCA diagnosed in patients during follow-up. Men with baseline PSA in the lowest stratum PSA [0.1 to 1.0 ng/mL] were at greatly reduced risk of PCA during follow-up. this half of the cohort with PSA ≤ 1.0 ng/mL had a 3.4% (95% CI [2.1, 4.5]). 10-year risk of PCA; 90% of the cancers were low-risk. By comparison, the other half had a 15 to 39% risk of cancer detection with a 39% risk in the highest stratum (3-10 ng/mL).
CONCLUSIONS: Optimal PSA screening frequency for men with PSA levels of 0.1 - 1.0 ng/mL may be up to every 10 years. This approach has the potential to dramatically reduce the cost of screening, reducing over-detection of inconsequential tumors, while maintaining detection of tumors for which treatment has been proven to reduce PCA mortality.
Written by:
Gelfond J, Choate K, Ankerst DP, Hernandez J, Leach RJ, Thompson IM Jr. Are you the author?
Department of Biostatistics and Epidemiology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Reference: J Urol. 2015 Feb 13. pii: S0022-5347(15)00292-X.
doi: 10.1016/j.juro.2015.02.043
PubMed Abstract
PMID: 25686543