Free PSA and Clinically Significant and Fatal Prostate Cancer in the PLCO Screening Trial
(2023) In The Journal of urology 210(4). p.630-638- Abstract
INTRODUCTION: We studied whether adding percent free prostate-specific antigen (%fPSA) to total PSA improves prediction of clinically significant prostate cancer (csPCa) and fatal PCa.
METHODS: 6727 men within the intervention arm of the Prostate, Lung, Colorectal and Ovarian Trial had baseline %fPSA. Of this cohort, 475 had csPCa and 98 had fatal PCa. Cumulative incidence and Cox analyses were conducted to evaluate the association between %fPSA/PSA and csPCa/fatal PCa. Harrell's concordance-index (C-index) evaluated predictive ability. Kaplan-Meier analysis assessed survival.
RESULTS: Median follow-up was 19.7 years, median baseline PSA was 1.19 ng/mL, median %fPSA was 18%. Cumulative incidence of fatal PCa for men with... (More)
INTRODUCTION: We studied whether adding percent free prostate-specific antigen (%fPSA) to total PSA improves prediction of clinically significant prostate cancer (csPCa) and fatal PCa.
METHODS: 6727 men within the intervention arm of the Prostate, Lung, Colorectal and Ovarian Trial had baseline %fPSA. Of this cohort, 475 had csPCa and 98 had fatal PCa. Cumulative incidence and Cox analyses were conducted to evaluate the association between %fPSA/PSA and csPCa/fatal PCa. Harrell's concordance-index (C-index) evaluated predictive ability. Kaplan-Meier analysis assessed survival.
RESULTS: Median follow-up was 19.7 years, median baseline PSA was 1.19 ng/mL, median %fPSA was 18%. Cumulative incidence of fatal PCa for men with baseline PSA≥2 ng/mL and %fPSA ≤10 was 3.2% and 6.1% at 15 and 25 years, compared to 0.03% and 1.1% for men with %fPSA >25%. In younger men (55-64 yr) with baseline PSA 2-10 ng/mL, C-index improved from 0.56 to 0.60 for csPCa and from 0.53 to 0.64 for fatal PCa with addition of %fPSA. In older men (65-74 yr), C-index improved for csPCa from 0.60 to 0.66, while no improvement in fatal PCa. Adjusting for age, digital rectal exam, family history of PCa, and total PSA, %fPSA was associated with csPCa (HR 1.05,
P < .001) per 1% decrease. %fPSA improved prediction of csPCa and fatal PCA for all race groups.
CONCLUSION: In a large US screening trial, the addition of %fPSA to total PSA in men with baseline PSA ≥2 ng/mL improved prediction of csPCa and fatal PCa. Free PSA should be used to risk-stratify screening and decrease unnecessary prostate biopsies.
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- author
- Yim, Kendrick ; Ma, Chaoran ; Carlsson, Sigrid LU ; Lilja, Hans LU ; Mucci, Lorelei ; Penney, Kathryn ; Kibel, Adam S ; Eggener, Scott and Preston, Mark A
- organization
- publishing date
- 2023-06-29
- type
- Contribution to journal
- publication status
- published
- subject
- in
- The Journal of urology
- volume
- 210
- issue
- 4
- pages
- 630 - 638
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- pmid:37384841
- scopus:85170294253
- ISSN
- 1527-3792
- DOI
- 10.1097/JU.0000000000003603
- language
- English
- LU publication?
- yes
- id
- acd23c28-462d-4bd9-981a-f9fb1016de47
- date added to LUP
- 2023-06-30 09:43:31
- date last changed
- 2024-08-11 12:10:24
@article{acd23c28-462d-4bd9-981a-f9fb1016de47, abstract = {{<p>INTRODUCTION: We studied whether adding percent free prostate-specific antigen (%fPSA) to total PSA improves prediction of clinically significant prostate cancer (csPCa) and fatal PCa.</p><p>METHODS: 6727 men within the intervention arm of the Prostate, Lung, Colorectal and Ovarian Trial had baseline %fPSA. Of this cohort, 475 had csPCa and 98 had fatal PCa. Cumulative incidence and Cox analyses were conducted to evaluate the association between %fPSA/PSA and csPCa/fatal PCa. Harrell's concordance-index (C-index) evaluated predictive ability. Kaplan-Meier analysis assessed survival.</p><p>RESULTS: Median follow-up was 19.7 years, median baseline PSA was 1.19 ng/mL, median %fPSA was 18%. Cumulative incidence of fatal PCa for men with baseline PSA≥2 ng/mL and %fPSA ≤10 was 3.2% and 6.1% at 15 and 25 years, compared to 0.03% and 1.1% for men with %fPSA >25%. In younger men (55-64 yr) with baseline PSA 2-10 ng/mL, C-index improved from 0.56 to 0.60 for csPCa and from 0.53 to 0.64 for fatal PCa with addition of %fPSA. In older men (65-74 yr), C-index improved for csPCa from 0.60 to 0.66, while no improvement in fatal PCa. Adjusting for age, digital rectal exam, family history of PCa, and total PSA, %fPSA was associated with csPCa (HR 1.05,<br> P < .001) per 1% decrease. %fPSA improved prediction of csPCa and fatal PCA for all race groups.<br> </p><p>CONCLUSION: In a large US screening trial, the addition of %fPSA to total PSA in men with baseline PSA ≥2 ng/mL improved prediction of csPCa and fatal PCa. Free PSA should be used to risk-stratify screening and decrease unnecessary prostate biopsies.</p>}}, author = {{Yim, Kendrick and Ma, Chaoran and Carlsson, Sigrid and Lilja, Hans and Mucci, Lorelei and Penney, Kathryn and Kibel, Adam S and Eggener, Scott and Preston, Mark A}}, issn = {{1527-3792}}, language = {{eng}}, month = {{06}}, number = {{4}}, pages = {{630--638}}, publisher = {{Lippincott Williams & Wilkins}}, series = {{The Journal of urology}}, title = {{Free PSA and Clinically Significant and Fatal Prostate Cancer in the PLCO Screening Trial}}, url = {{http://dx.doi.org/10.1097/JU.0000000000003603}}, doi = {{10.1097/JU.0000000000003603}}, volume = {{210}}, year = {{2023}}, }