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Free PSA and Clinically Significant and Fatal Prostate Cancer in the PLCO Screening Trial

Yim, Kendrick ; Ma, Chaoran ; Carlsson, Sigrid LU ; Lilja, Hans LU orcid ; Mucci, Lorelei ; Penney, Kathryn ; Kibel, Adam S ; Eggener, Scott and Preston, Mark A (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
; ; ; ; ; ; ; and
organization
publishing date
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
  • scopus:85170294253
  • pmid:37384841
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
2024-04-20 01:56:26
@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 &gt;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 &lt; .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}},
}