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

Authors

  • Hans Lilja MD, PhD,

    Corresponding author
    1. Department of Clinical Laboratories, Memorial Sloan-Kettering Cancer Center, New York, New York
    2. Department of Surgery (Urology), Memorial Sloan-Kettering Cancer Center, New York, New York
    3. Department of Medicine (GU-Oncology), Memorial Sloan-Kettering Cancer Center, New York, New York
    4. Department of Laboratory Medicine and Clinical Sciences, Lund University, University Hospital UMAS, Malmö, Sweden
    • Departments of Clinical Laboratories, Surgery, and Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Box 213, New York, NY 10065
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    • Fax: (646) 422-2379

  • Angel M. Cronin MSc,

    1. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • Anders Dahlin MD,

    1. Department of Clinical Microbiology, Lund University, University Hospital UMAS, Malmö, Sweden
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  • Jonas Manjer MD, PhD,

    1. Department of Surgery, Lund University, University Hospital UMAS, Malmö, Sweden
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  • Peter M. Nilsson MD,

    1. Department of Medicine in Malmö, Lund University, University Hospital UMAS, Malmö, Sweden
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  • James A. Eastham MD,

    1. Department of Surgery (Urology), Memorial Sloan-Kettering Cancer Center, New York, New York
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  • Anders S. Bjartell MD, PhD,

    1. Department of Laboratory Medicine and Clinical Sciences, Lund University, University Hospital UMAS, Malmö, Sweden
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  • Peter T. Scardino MD,

    1. Department of Surgery (Urology), Memorial Sloan-Kettering Cancer Center, New York, New York
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  • David Ulmert MD, PhD,

    1. Department of Laboratory Medicine and Clinical Sciences, Lund University, University Hospital UMAS, Malmö, Sweden
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  • Andrew J. Vickers PhD

    1. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • See editorial on pages 1110-2, this issue.

Abstract

BACKGROUND:

We previously reported that a single prostate-specific antigen (PSA) measured at ages 44-50 was highly predictive of subsequent prostate cancer diagnosis in an unscreened population. Here we report an additional 7 years of follow-up. This provides replication using 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 city (74% participation rate) during 1974-1986 at ages 33-50. Through 2006, prostate cancer was diagnosed in 1408 participants; we measured PSA in archived plasma for 1312 of these cases (93%) 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% of advanced cases (95% CI, 77%-86%) found in men with PSA above the median (0.63 ng/mL at ages 44-50).

CONCLUSIONS:

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 low-risk 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 benefit to harm for screening. Cancer 2011. © 2010 American Cancer Society.

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