Prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate-specific antigen at or before age 50

Hans Lilja, Angel M. Cronin, Anders Dahlin, Jonas Manjer, Peter M. Nilsson, James A. Eastham, Anders S. Bjartell, Peter T. Scardino, David Ulmert, Andrew J. Vickers
2010 Cancer  
Background-We previously reported that a single prostate-specific antigen (PSA) measured at age 44-50 was highly predictive of subsequent prostate cancer diagnosis in an unscreened population. Here we report an additional seven years of follow-up. This provides a replication on an independent data set, and allows estimates of the association between early PSA and subsequent advanced cancer (clinical stage ≥T3 or metastases at diagnosis). Methods-Blood was collected from 21,277 men in a Swedish
more » ... ity (74% participation rate) during 1974-1986 at age 33-50. Through 2006, prostate cancer was diagnosed in 1408 participants; we measured PSA in archived plasma for 1312 (93%) of these cases and for 3728 controls. Results-At a median follow-up of 23 years, baseline PSA was strongly associated with subsequent prostate cancer (area-under-the-curve 0.72; 95% CI 0.70, 0.74; for advanced cancer 0.75; 95% CI 0.72, 0.78). Associations between PSA and prostate cancer were virtually identical for the initial and replication data sets with 81% (95% CI 77%, 86%) of advanced cases found in men with PSA above the median (0.63 ng/ml at age 44 -50). Conclusion-A single PSA at or before age 50 predicts advanced prostate cancer diagnosed up to 30 years later. Use of early PSA to stratify risk would allow a large group of men to be screened less often but increase frequency of testing on a more limited number of high-risk men. This is likely to improve the ratio of benefits to harms for screening.
doi:10.1002/cncr.25568 pmid:20960520 pmcid:PMC3412541 fatcat:b7viu2tmonactijfmc7k5iyzzu