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Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study

Vickers, Andrew J.; Ulmert, David LU ; Sjoberg, Daniel D.; Bennette, Caroline J.; Björk, Thomas LU ; Gerdtsson, Axel LU ; Manjer, Jonas LU ; Nilsson, Peter LU ; Dahlin, Anders LU and Bjartell, Anders LU , et al. (2013) In B M J: British Medical Journal1995-01-01+01:00 346. p.2023-2023
Abstract
Objective To determine the association between concentration of prostate specific antigen (PSA) at age 40-55 and subsequent risk of prostate cancer metastasis and mortality in an unscreened population to evaluate when to start screening for prostate cancer and whether rescreening could be risk stratified. Design Case-control study with 1: 3 matching nested within a highly representative population based cohort study. Setting Malmo Preventive Project, Sweden. Participants 21 277 Swedish men aged 27-52 (74% of the eligible population) who provided blood at baseline in 1974-84, and 4922 men invited to provide a second sample six years later. Rates of PSA testing remained extremely low during median follow-up of 27 years. Main outcome measures... (More)
Objective To determine the association between concentration of prostate specific antigen (PSA) at age 40-55 and subsequent risk of prostate cancer metastasis and mortality in an unscreened population to evaluate when to start screening for prostate cancer and whether rescreening could be risk stratified. Design Case-control study with 1: 3 matching nested within a highly representative population based cohort study. Setting Malmo Preventive Project, Sweden. Participants 21 277 Swedish men aged 27-52 (74% of the eligible population) who provided blood at baseline in 1974-84, and 4922 men invited to provide a second sample six years later. Rates of PSA testing remained extremely low during median follow-up of 27 years. Main outcome measures Metastasis or death from prostate cancer ascertained by review of case notes. Results Risk of death from prostate cancer was associated with baseline PSA: 44% (95% confidence interval 34% to 53%) of deaths occurred in men with a PSA concentration in the highest 10th of the distribution of concentrations at age 45-49 (>= 1.6 mu g/L), with a similar proportion for the highest 10th at age 51-55 (>= 2.4 mu g/L: 44%, 32% to 56%). Although a 25-30 year risk of prostate cancer metastasis could not be ruled out by concentrations below the median at age 45-49 (0.68 mu g/L) or 51-55 (0.85 mu g/L), the 15 year risk remained low at 0.09% (0.03% to 0.23%) at age 45-49 and 0.28% (0.11% to 0.66%) at age 51-55, suggesting that longer intervals between screening would be appropriate in this group. Conclusion Measurement of PSA concentration in early midlife can identify a small group of men at increased risk of prostate cancer metastasis several decades later. Careful surveillance is warranted in these men. Given existing data on the risk of death by PSA concentration at age 60, these results suggest that three lifetime PSA tests (mid to late 40s, early 50s, and 60) are probably sufficient for at least half of men. (Less)
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B M J: British Medical Journal1995-01-01+01:00
volume
346
pages
2023 - 2023
publisher
BMJ Publishing Group
external identifiers
  • wos:000317962900002
  • scopus:84878298992
ISSN
1756-1833
DOI
10.1136/bmj.f2023
language
English
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yes
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a78fd8f9-1c13-4d95-b3fc-f2171c38a69c (old id 3847417)
date added to LUP
2013-07-01 07:01:44
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2019-07-16 01:06:01
@article{a78fd8f9-1c13-4d95-b3fc-f2171c38a69c,
  abstract     = {Objective To determine the association between concentration of prostate specific antigen (PSA) at age 40-55 and subsequent risk of prostate cancer metastasis and mortality in an unscreened population to evaluate when to start screening for prostate cancer and whether rescreening could be risk stratified. Design Case-control study with 1: 3 matching nested within a highly representative population based cohort study. Setting Malmo Preventive Project, Sweden. Participants 21 277 Swedish men aged 27-52 (74% of the eligible population) who provided blood at baseline in 1974-84, and 4922 men invited to provide a second sample six years later. Rates of PSA testing remained extremely low during median follow-up of 27 years. Main outcome measures Metastasis or death from prostate cancer ascertained by review of case notes. Results Risk of death from prostate cancer was associated with baseline PSA: 44% (95% confidence interval 34% to 53%) of deaths occurred in men with a PSA concentration in the highest 10th of the distribution of concentrations at age 45-49 (>= 1.6 mu g/L), with a similar proportion for the highest 10th at age 51-55 (>= 2.4 mu g/L: 44%, 32% to 56%). Although a 25-30 year risk of prostate cancer metastasis could not be ruled out by concentrations below the median at age 45-49 (0.68 mu g/L) or 51-55 (0.85 mu g/L), the 15 year risk remained low at 0.09% (0.03% to 0.23%) at age 45-49 and 0.28% (0.11% to 0.66%) at age 51-55, suggesting that longer intervals between screening would be appropriate in this group. Conclusion Measurement of PSA concentration in early midlife can identify a small group of men at increased risk of prostate cancer metastasis several decades later. Careful surveillance is warranted in these men. Given existing data on the risk of death by PSA concentration at age 60, these results suggest that three lifetime PSA tests (mid to late 40s, early 50s, and 60) are probably sufficient for at least half of men.},
  author       = {Vickers, Andrew J. and Ulmert, David and Sjoberg, Daniel D. and Bennette, Caroline J. and Björk, Thomas and Gerdtsson, Axel and Manjer, Jonas and Nilsson, Peter and Dahlin, Anders and Bjartell, Anders and Scardino, Peter T. and Lilja, Hans},
  issn         = {1756-1833},
  language     = {eng},
  pages        = {2023--2023},
  publisher    = {BMJ Publishing Group},
  series       = {B M J: British Medical Journal1995-01-01+01:00},
  title        = {Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study},
  url          = {http://dx.doi.org/10.1136/bmj.f2023},
  volume       = {346},
  year         = {2013},
}