Prostate-specific antigen levels at age 60 and lifetime risk of lethal prostate cancer
Vertosick, Emily A LU ; Vickers, Andrew ; Dahlin, Anders LU ; Ulmert, David LU ; Carlsson, Sigrid V LU ; Eastham, James ; Bjartell, Anders LU and Lilja, Hans LU
(2025)
In Journal of the National Cancer Institute
- Abstract
INTRODUCTION: We investigated the natural history of the relationship between PSA at age 60 and lifetime risk of prostate cancer death in an unscreened cohort followed for 40 years, the Malmö Preventive Project. We also investigated whether percent free PSA could risk-stratify men with low PSAs.
METHODS: The cohort included 1162 men aged 58-62 at blood draw in 1981-82, with 1151 deaths by December 31, 2020. Total and free PSA were measured for 130 men with prostate cancer and 517 without prostate cancer. Lorenz curves were calculated for life years lost to prostate cancer by baseline PSA level.
RESULTS: Total PSA at age 60 remained highly predictive for full lifetime risk of lethal prostate cancer (C-index 0.87, 95% CI 0.82,... (More)
INTRODUCTION: We investigated the natural history of the relationship between PSA at age 60 and lifetime risk of prostate cancer death in an unscreened cohort followed for 40 years, the Malmö Preventive Project. We also investigated whether percent free PSA could risk-stratify men with low PSAs.
METHODS: The cohort included 1162 men aged 58-62 at blood draw in 1981-82, with 1151 deaths by December 31, 2020. Total and free PSA were measured for 130 men with prostate cancer and 517 without prostate cancer. Lorenz curves were calculated for life years lost to prostate cancer by baseline PSA level.
RESULTS: Total PSA at age 60 remained highly predictive for full lifetime risk of lethal prostate cancer (C-index 0.87, 95% CI 0.82, 0.92). More than half of the life years lost to prostate cancer in this cohort were in men who had a PSA >4.0 ng/ml (59%, 95% CI 54%, 63%) at age 60, with 85% (95% CI 81%, 89%) and 92% (95% CI 90%, 94%) in men with a PSA >2.0 ng/ml and >1.0 ng/ml respectively. Percent free PSA did not aid risk stratification in men with low PSA.
CONCLUSION: Men with a PSA below 1-2 ng/ml at age 60 are at low risk for lethal prostate cancer and do not require further PSA screening. Unlike a proven role in men with elevated PSA, percent free PSA is not useful in informing the decision to stop or continue further PSA screening for men with PSA < 2 ng/ml at age 60.
(Less)
- author
- Vertosick, Emily A
LU
; Vickers, Andrew
; Dahlin, Anders
LU
; Ulmert, David
LU
; Carlsson, Sigrid V
LU
; Eastham, James
; Bjartell, Anders
LU
and Lilja, Hans
LU
- organization
- publishing date
- 2025-09-19
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- Journal of the National Cancer Institute
- publisher
- Oxford University Press
- external identifiers
-
- pmid:40973921
- ISSN
- 1460-2105
- DOI
- 10.1093/jnci/djaf271
- language
- English
- LU publication?
- yes
- additional info
- © The Author(s) 2025. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
- id
- ad032162-6cff-40d0-b30c-7163d2107184
- date added to LUP
- 2025-09-21 13:15:08
- date last changed
- 2025-09-22 08:03:41
@article{ad032162-6cff-40d0-b30c-7163d2107184,
abstract = {{<p>INTRODUCTION: We investigated the natural history of the relationship between PSA at age 60 and lifetime risk of prostate cancer death in an unscreened cohort followed for 40 years, the Malmö Preventive Project. We also investigated whether percent free PSA could risk-stratify men with low PSAs.</p><p>METHODS: The cohort included 1162 men aged 58-62 at blood draw in 1981-82, with 1151 deaths by December 31, 2020. Total and free PSA were measured for 130 men with prostate cancer and 517 without prostate cancer. Lorenz curves were calculated for life years lost to prostate cancer by baseline PSA level.</p><p>RESULTS: Total PSA at age 60 remained highly predictive for full lifetime risk of lethal prostate cancer (C-index 0.87, 95% CI 0.82, 0.92). More than half of the life years lost to prostate cancer in this cohort were in men who had a PSA >4.0 ng/ml (59%, 95% CI 54%, 63%) at age 60, with 85% (95% CI 81%, 89%) and 92% (95% CI 90%, 94%) in men with a PSA >2.0 ng/ml and >1.0 ng/ml respectively. Percent free PSA did not aid risk stratification in men with low PSA.</p><p>CONCLUSION: Men with a PSA below 1-2 ng/ml at age 60 are at low risk for lethal prostate cancer and do not require further PSA screening. Unlike a proven role in men with elevated PSA, percent free PSA is not useful in informing the decision to stop or continue further PSA screening for men with PSA < 2 ng/ml at age 60.</p>}},
author = {{Vertosick, Emily A and Vickers, Andrew and Dahlin, Anders and Ulmert, David and Carlsson, Sigrid V and Eastham, James and Bjartell, Anders and Lilja, Hans}},
issn = {{1460-2105}},
language = {{eng}},
month = {{09}},
publisher = {{Oxford University Press}},
series = {{Journal of the National Cancer Institute}},
title = {{Prostate-specific antigen levels at age 60 and lifetime risk of lethal prostate cancer}},
url = {{http://dx.doi.org/10.1093/jnci/djaf271}},
doi = {{10.1093/jnci/djaf271}},
year = {{2025}},
}