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Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer : Case-control study

Vickers, Andrew J. ; Cronin, Angel M. ; Björk, Thomas LU ; Manjer, Jonas LU ; Nilsson, Peter M. LU ; Dahlin, Anders LU ; Bjartell, Anders LU ; Scardino, Peter T. ; Ulmert, David LU and Lilja, Hans LU orcid (2010) In BMJ (Online) 341(7773).
Abstract

Objective: To determine the relation between concentrations of prostate specific antigen at age 60 and subsequent diagnosis of clinically relevant prostate cancer in an unscreened population to evaluate whether screening for prostate cancer and chemoprevention could be stratified by risk. Design: Case-control study with 1:3 matching nested within a highly representative population based cohort study. Setting: General population of Sweden taking part in the Malmo Preventive Project. Cancer registry at the National Board of Health and Welfare. Participants: 1167 men aged 60 who provided blood samples in 1981 and were followed up to age 85. Main outcome measures: Metastasis or death from prostate cancer. Results: The rate of screening... (More)

Objective: To determine the relation between concentrations of prostate specific antigen at age 60 and subsequent diagnosis of clinically relevant prostate cancer in an unscreened population to evaluate whether screening for prostate cancer and chemoprevention could be stratified by risk. Design: Case-control study with 1:3 matching nested within a highly representative population based cohort study. Setting: General population of Sweden taking part in the Malmo Preventive Project. Cancer registry at the National Board of Health and Welfare. Participants: 1167 men aged 60 who provided blood samples in 1981 and were followed up to age 85. Main outcome measures: Metastasis or death from prostate cancer. Results: The rate of screening during the course of the study was low. There were 43 cases of metastasis and 35 deaths from prostate cancer. Concentration of prostate specific antigen at age 60 was associated with prostate cancer metastasis (area under the curve 0.86, 95% confidence interval 0.79 to 0.92; P<0.001) and death from prostate cancer (0.90, 0.84 to 0.96; P<0.001). The greater the number for the area under the curve (values from 0 to 1) the better the test. Although only a minority of the men with concentrations in the top quarter (>2 ng/ml) develop fatal prostate cancer, 90% (78% to 100%) of deaths from prostate cancer occurred in these men. Conversely, men aged 60 with concentrations at the median or lower (≤1 ng/ml) were unlikely to have clinically relevant prostate cancer (0.5% risk of metastasis by age 85 and 0.2% risk of death from prostate cancer). Conclusions: The concentration of prostate specific antigen at age 60 predicts lifetime risk of metastasis and death from prostate cancer. Though men aged 60 with concentrations below the median (≤1 ng/ml) might harbour prostate cancer, it is unlikely to become life threatening. Such men could be exempted from further screening, which should instead focus on men with higher concentrations.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BMJ (Online)
volume
341
issue
7773
article number
c4521
publisher
BMJ Publishing Group
external identifiers
  • pmid:20843935
  • scopus:77956811462
ISSN
1756-1833
DOI
10.1136/bmj.c4521
language
English
LU publication?
yes
id
a722914e-2e7e-412c-9809-81ce97eb7951
date added to LUP
2022-12-06 15:38:24
date last changed
2024-04-18 16:03:57
@article{a722914e-2e7e-412c-9809-81ce97eb7951,
  abstract     = {{<p>Objective: To determine the relation between concentrations of prostate specific antigen at age 60 and subsequent diagnosis of clinically relevant prostate cancer in an unscreened population to evaluate whether screening for prostate cancer and chemoprevention could be stratified by risk. Design: Case-control study with 1:3 matching nested within a highly representative population based cohort study. Setting: General population of Sweden taking part in the Malmo Preventive Project. Cancer registry at the National Board of Health and Welfare. Participants: 1167 men aged 60 who provided blood samples in 1981 and were followed up to age 85. Main outcome measures: Metastasis or death from prostate cancer. Results: The rate of screening during the course of the study was low. There were 43 cases of metastasis and 35 deaths from prostate cancer. Concentration of prostate specific antigen at age 60 was associated with prostate cancer metastasis (area under the curve 0.86, 95% confidence interval 0.79 to 0.92; P&lt;0.001) and death from prostate cancer (0.90, 0.84 to 0.96; P&lt;0.001). The greater the number for the area under the curve (values from 0 to 1) the better the test. Although only a minority of the men with concentrations in the top quarter (&gt;2 ng/ml) develop fatal prostate cancer, 90% (78% to 100%) of deaths from prostate cancer occurred in these men. Conversely, men aged 60 with concentrations at the median or lower (≤1 ng/ml) were unlikely to have clinically relevant prostate cancer (0.5% risk of metastasis by age 85 and 0.2% risk of death from prostate cancer). Conclusions: The concentration of prostate specific antigen at age 60 predicts lifetime risk of metastasis and death from prostate cancer. Though men aged 60 with concentrations below the median (≤1 ng/ml) might harbour prostate cancer, it is unlikely to become life threatening. Such men could be exempted from further screening, which should instead focus on men with higher concentrations.</p>}},
  author       = {{Vickers, Andrew J. and Cronin, Angel M. and Björk, Thomas and Manjer, Jonas and Nilsson, Peter M. and Dahlin, Anders and Bjartell, Anders and Scardino, Peter T. and Ulmert, David and Lilja, Hans}},
  issn         = {{1756-1833}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{7773}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ (Online)}},
  title        = {{Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer : Case-control study}},
  url          = {{http://dx.doi.org/10.1136/bmj.c4521}},
  doi          = {{10.1136/bmj.c4521}},
  volume       = {{341}},
  year         = {{2010}},
}