Intermediate-Term Risk of Prostate Cancer is Directly Related to Baseline Prostate Specific Antigen: Implications for Reducing the Burden of Prostate Specific Antigen Screening

Jonathan A Gelfond, Kara Choate, Donna P Ankerst, Javier Hernandez, Robin J Leach, Ian M. Thompson

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose: Prostate specific antigen screening is controversial, as a large number of men must be screened annually to achieve a benefit. We sought to determine whether baseline prostate specific antigen could reliably predict subsequent risk of prostate cancer and risk of consequential prostate cancer. Materials and Methods: A multiethnic cohort of 2,923 prostate cancer-free men was recruited between 2000 and 2012, and followed for a median of 7.5 years. Baseline prostate specific antigen was stratified into 6 strata and relative hazards of prostate cancer detection for each prostate specific antigen stratum were estimated, adjusting for ethnicity, family history and age. Results: During followup 289 patients were diagnosed with prostate cancer. Men with baseline prostate specific antigen in the lowest stratum (0.1 to 1.0 ng/ml) were at greatly reduced risk for prostate cancer during followup. This half of the cohort with prostate specific antigen 1.0 ng/ml or less were at 3.4% (95% CI 2.1, 4.5) 10-year risk of prostate cancer and 90% of the cancers were low risk. By comparison the other half were at 15% to 39% risk of cancer detection with a 39% risk in the highest stratum (3 to 10 ng/ml). Conclusions: Optimal prostate specific antigen screening frequency for men with aprostate specific antigen level of 0.1 to 1.0 ng/ml may be up to every 10 years. Thisapproach has the potential to dramatically reduce the cost of screening, decreasing over detection of inconsequential tumors, while maintaining detection of tumors for which treatment has been proven to reduce prostate cancer mortality.

Original languageEnglish (US)
JournalJournal of Urology
DOIs
StateAccepted/In press - 2015

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Prostate-Specific Antigen
Prostatic Neoplasms
Neoplasms
Antigens
Costs and Cost Analysis
Mortality

Keywords

  • Mass screening
  • Prognosis
  • Prostate-specific antigen
  • Prostatic neoplasms
  • Risk

ASJC Scopus subject areas

  • Urology

Cite this

@article{e826cff5e86a4acdb826ba0224efad56,
title = "Intermediate-Term Risk of Prostate Cancer is Directly Related to Baseline Prostate Specific Antigen: Implications for Reducing the Burden of Prostate Specific Antigen Screening",
abstract = "Purpose: Prostate specific antigen screening is controversial, as a large number of men must be screened annually to achieve a benefit. We sought to determine whether baseline prostate specific antigen could reliably predict subsequent risk of prostate cancer and risk of consequential prostate cancer. Materials and Methods: A multiethnic cohort of 2,923 prostate cancer-free men was recruited between 2000 and 2012, and followed for a median of 7.5 years. Baseline prostate specific antigen was stratified into 6 strata and relative hazards of prostate cancer detection for each prostate specific antigen stratum were estimated, adjusting for ethnicity, family history and age. Results: During followup 289 patients were diagnosed with prostate cancer. Men with baseline prostate specific antigen in the lowest stratum (0.1 to 1.0 ng/ml) were at greatly reduced risk for prostate cancer during followup. This half of the cohort with prostate specific antigen 1.0 ng/ml or less were at 3.4{\%} (95{\%} CI 2.1, 4.5) 10-year risk of prostate cancer and 90{\%} of the cancers were low risk. By comparison the other half were at 15{\%} to 39{\%} risk of cancer detection with a 39{\%} risk in the highest stratum (3 to 10 ng/ml). Conclusions: Optimal prostate specific antigen screening frequency for men with aprostate specific antigen level of 0.1 to 1.0 ng/ml may be up to every 10 years. Thisapproach has the potential to dramatically reduce the cost of screening, decreasing over detection of inconsequential tumors, while maintaining detection of tumors for which treatment has been proven to reduce prostate cancer mortality.",
keywords = "Mass screening, Prognosis, Prostate-specific antigen, Prostatic neoplasms, Risk",
author = "Gelfond, {Jonathan A} and Kara Choate and Ankerst, {Donna P} and Javier Hernandez and Leach, {Robin J} and Thompson, {Ian M.}",
year = "2015",
doi = "10.1016/j.juro.2015.02.043",
language = "English (US)",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Intermediate-Term Risk of Prostate Cancer is Directly Related to Baseline Prostate Specific Antigen

T2 - Implications for Reducing the Burden of Prostate Specific Antigen Screening

AU - Gelfond, Jonathan A

AU - Choate, Kara

AU - Ankerst, Donna P

AU - Hernandez, Javier

AU - Leach, Robin J

AU - Thompson, Ian M.

PY - 2015

Y1 - 2015

N2 - Purpose: Prostate specific antigen screening is controversial, as a large number of men must be screened annually to achieve a benefit. We sought to determine whether baseline prostate specific antigen could reliably predict subsequent risk of prostate cancer and risk of consequential prostate cancer. Materials and Methods: A multiethnic cohort of 2,923 prostate cancer-free men was recruited between 2000 and 2012, and followed for a median of 7.5 years. Baseline prostate specific antigen was stratified into 6 strata and relative hazards of prostate cancer detection for each prostate specific antigen stratum were estimated, adjusting for ethnicity, family history and age. Results: During followup 289 patients were diagnosed with prostate cancer. Men with baseline prostate specific antigen in the lowest stratum (0.1 to 1.0 ng/ml) were at greatly reduced risk for prostate cancer during followup. This half of the cohort with prostate specific antigen 1.0 ng/ml or less were at 3.4% (95% CI 2.1, 4.5) 10-year risk of prostate cancer and 90% of the cancers were low risk. By comparison the other half were at 15% to 39% risk of cancer detection with a 39% risk in the highest stratum (3 to 10 ng/ml). Conclusions: Optimal prostate specific antigen screening frequency for men with aprostate specific antigen level of 0.1 to 1.0 ng/ml may be up to every 10 years. Thisapproach has the potential to dramatically reduce the cost of screening, decreasing over detection of inconsequential tumors, while maintaining detection of tumors for which treatment has been proven to reduce prostate cancer mortality.

AB - Purpose: Prostate specific antigen screening is controversial, as a large number of men must be screened annually to achieve a benefit. We sought to determine whether baseline prostate specific antigen could reliably predict subsequent risk of prostate cancer and risk of consequential prostate cancer. Materials and Methods: A multiethnic cohort of 2,923 prostate cancer-free men was recruited between 2000 and 2012, and followed for a median of 7.5 years. Baseline prostate specific antigen was stratified into 6 strata and relative hazards of prostate cancer detection for each prostate specific antigen stratum were estimated, adjusting for ethnicity, family history and age. Results: During followup 289 patients were diagnosed with prostate cancer. Men with baseline prostate specific antigen in the lowest stratum (0.1 to 1.0 ng/ml) were at greatly reduced risk for prostate cancer during followup. This half of the cohort with prostate specific antigen 1.0 ng/ml or less were at 3.4% (95% CI 2.1, 4.5) 10-year risk of prostate cancer and 90% of the cancers were low risk. By comparison the other half were at 15% to 39% risk of cancer detection with a 39% risk in the highest stratum (3 to 10 ng/ml). Conclusions: Optimal prostate specific antigen screening frequency for men with aprostate specific antigen level of 0.1 to 1.0 ng/ml may be up to every 10 years. Thisapproach has the potential to dramatically reduce the cost of screening, decreasing over detection of inconsequential tumors, while maintaining detection of tumors for which treatment has been proven to reduce prostate cancer mortality.

KW - Mass screening

KW - Prognosis

KW - Prostate-specific antigen

KW - Prostatic neoplasms

KW - Risk

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