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Baseline Serum Prostate-specific Antigen Value Predicts the Risk of Subsequent Prostate Cancer Death-Results from the Norwegian Prostate Cancer Consortium

Bjerner, Johan ; Bratt, Ola LU ; Aas, Kirsti ; Albertsen, Peter C ; Fosså, Sophie D ; Kvåle, Rune ; Lilja, Hans LU orcid ; Müller, Christoph LU ; Müller, Stig and Stensvold, Andreas , et al. (2023) In European Urology
Abstract

BACKGROUND: Prostate-specific antigen (PSA) levels in midlife are strongly associated with the long-term risk of lethal prostate cancer in cohorts not subject to screening. This is the first study evaluating the association between PSA levels drawn as part of routine medical care in the Norwegian population and prostate cancer incidence and mortality.

OBJECTIVE: To determine the association between midlife PSA levels <4.0 ng/ml, drawn as part of routine medical care, and long-term risk of prostate cancer death.

DESIGN, SETTING, AND PARTICIPANTS: The Norwegian Prostate Cancer Consortium collected >8 million PSA results from >1 million Norwegian males ≥40 yr of age. We studied 176 099 men (predefined age strata: 40-54... (More)

BACKGROUND: Prostate-specific antigen (PSA) levels in midlife are strongly associated with the long-term risk of lethal prostate cancer in cohorts not subject to screening. This is the first study evaluating the association between PSA levels drawn as part of routine medical care in the Norwegian population and prostate cancer incidence and mortality.

OBJECTIVE: To determine the association between midlife PSA levels <4.0 ng/ml, drawn as part of routine medical care, and long-term risk of prostate cancer death.

DESIGN, SETTING, AND PARTICIPANTS: The Norwegian Prostate Cancer Consortium collected >8 million PSA results from >1 million Norwegian males ≥40 yr of age. We studied 176 099 men (predefined age strata: 40-54 and 55-69 yr) without a prior prostate cancer diagnosis who had a nonelevated baseline PSA level (<4.0 ng/ml) between January 1, 1995 and December 31, 2005.

INTERVENTION: Baseline PSA.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We assessed the 16-yr risk of prostate cancer mortality. We calculated the discrimination (C-index) between predefined PSA strata (<0.5, 0.5-0.9, 1.0-1.9, 2.0-2.9, and 3.0-3.9 ng/ml) and subsequent prostate cancer death. Survival curves were plotted using the Kaplan-Meier method.

RESULTS AND LIMITATIONS: The median follow-up time of men who did not get prostate cancer was 17.9 yr. Overall, 84% of men had a baseline PSA level of <2.0 ng/ml and 1346 men died from prostate cancer, with 712 deaths (53%) occurring in the 16% of men with the highest baseline PSA of 2.0-3.9 ng/ml. Baseline PSA levels were associated with prostate cancer mortality (C-index 0.72 for both age groups, 40-54 and 55-69 yr). The fact that the reason for any given PSA measurement remains unknown represents a limitation.

CONCLUSIONS: We replicated prior studies that baseline PSA at age 40-69 yr can be used to stratify a man's risk of dying from prostate cancer within the next 15-20 yr.

PATIENT SUMMARY: A prostate-specific antigen level obtained as part of routine medical care is strongly associated with a man's risk of dying from prostate cancer in the next two decades.

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type
Contribution to journal
publication status
epub
subject
in
European Urology
publisher
Elsevier
external identifiers
  • scopus:85158911417
  • pmid:37169639
ISSN
0302-2838
DOI
10.1016/j.eururo.2023.04.028
language
English
LU publication?
yes
additional info
Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.
id
91ecbe32-6c23-4c6a-a9b0-21719a34ff56
date added to LUP
2023-05-25 17:57:14
date last changed
2024-06-29 04:35:23
@article{91ecbe32-6c23-4c6a-a9b0-21719a34ff56,
  abstract     = {{<p>BACKGROUND: Prostate-specific antigen (PSA) levels in midlife are strongly associated with the long-term risk of lethal prostate cancer in cohorts not subject to screening. This is the first study evaluating the association between PSA levels drawn as part of routine medical care in the Norwegian population and prostate cancer incidence and mortality.</p><p>OBJECTIVE: To determine the association between midlife PSA levels &lt;4.0 ng/ml, drawn as part of routine medical care, and long-term risk of prostate cancer death.</p><p>DESIGN, SETTING, AND PARTICIPANTS: The Norwegian Prostate Cancer Consortium collected &gt;8 million PSA results from &gt;1 million Norwegian males ≥40 yr of age. We studied 176 099 men (predefined age strata: 40-54 and 55-69 yr) without a prior prostate cancer diagnosis who had a nonelevated baseline PSA level (&lt;4.0 ng/ml) between January 1, 1995 and December 31, 2005.</p><p>INTERVENTION: Baseline PSA.</p><p>OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We assessed the 16-yr risk of prostate cancer mortality. We calculated the discrimination (C-index) between predefined PSA strata (&lt;0.5, 0.5-0.9, 1.0-1.9, 2.0-2.9, and 3.0-3.9 ng/ml) and subsequent prostate cancer death. Survival curves were plotted using the Kaplan-Meier method.</p><p>RESULTS AND LIMITATIONS: The median follow-up time of men who did not get prostate cancer was 17.9 yr. Overall, 84% of men had a baseline PSA level of &lt;2.0 ng/ml and 1346 men died from prostate cancer, with 712 deaths (53%) occurring in the 16% of men with the highest baseline PSA of 2.0-3.9 ng/ml. Baseline PSA levels were associated with prostate cancer mortality (C-index 0.72 for both age groups, 40-54 and 55-69 yr). The fact that the reason for any given PSA measurement remains unknown represents a limitation.</p><p>CONCLUSIONS: We replicated prior studies that baseline PSA at age 40-69 yr can be used to stratify a man's risk of dying from prostate cancer within the next 15-20 yr.</p><p>PATIENT SUMMARY: A prostate-specific antigen level obtained as part of routine medical care is strongly associated with a man's risk of dying from prostate cancer in the next two decades.</p>}},
  author       = {{Bjerner, Johan and Bratt, Ola and Aas, Kirsti and Albertsen, Peter C and Fosså, Sophie D and Kvåle, Rune and Lilja, Hans and Müller, Christoph and Müller, Stig and Stensvold, Andreas and Thomas, Owen and Røe, Oluf D and Vickers, Andrew and Walz, Jochen and Carlsson, Sigrid V and Oldenburg, Jan}},
  issn         = {{0302-2838}},
  language     = {{eng}},
  month        = {{05}},
  publisher    = {{Elsevier}},
  series       = {{European Urology}},
  title        = {{Baseline Serum Prostate-specific Antigen Value Predicts the Risk of Subsequent Prostate Cancer Death-Results from the Norwegian Prostate Cancer Consortium}},
  url          = {{http://dx.doi.org/10.1016/j.eururo.2023.04.028}},
  doi          = {{10.1016/j.eururo.2023.04.028}},
  year         = {{2023}},
}