Abstract
The use of prostate-specific antigen (PSA) screening for prostate cancer is controversial because of the risk of overdiagnosis and overtreatment of indolent cancers. Optimal screening strategies are highly sought. To estimate the long-term risk of any prostate cancer and clinically significant prostate cancer based on baseline PSA levels among men aged 55 to 60 years. This secondary analysis of a cohort in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial uses actuarial analysis to analyze the association of baseline PSA levels with long-term risk of any prostate cancer and of clinically significant prostate cancer among men aged 55 to 60 years enrolled in the screening group of the trial between 1993 and 2001. Single PSA measurement at study entry. Long-term risk of any prostate cancer and clinically significant prostate cancer diagnoses. There were 10 968 men aged 55 to 60 years (median [interquartile range] age, 57 [55-58] years) at study enrollment in the screening group of the PLCO Cancer Screening Trial who had long-term follow-up. Actuarial 13-year incidences of clinically significant prostate cancer diagnosis among participants with a baseline PSA of 0.49 ng/mL or less was 0.4% (95% CI, 0%-0.8%); 0.50-0.99 ng/mL, 1.5% (95% CI, 1.1%-1.9%); 1.00-1.99 ng/mL, 5.4% (95% CI, 4.4%-6.4%); 2.00-2.99 ng/mL, 10.6% (95% CI, 8.3%-12.9%); 3.00-3.99 ng/mL, 15.3% (95% CI, 11.4%-19.2%); and 4.00 ng/mL and greater, 29.5% (95% CI, 24.2%-34.8%) (all pairwise log-rank P ≤ .004). Only 15 prostate cancer-specific deaths occurred during 13 years of follow-up, and 9 (60.0%) were among men with a baseline PSA level of 2.00 ng/mL or higher. In this secondary analysis of a cohort from the PLCO Cancer Screening Trial, baseline PSA levels among men aged 55 to 60 years were associated with long-term risk of clinically significant prostate cancer. These findings suggest that repeated screening can be less frequent among men aged 55 to 60 years with a low baseline PSA level (ie, <2.00 ng/mL) and possibly discontinued among those with baseline PSA levels of less than 1.00 ng/mL.
Highlights
Since the introduction of widespread prostate-specific antigen (PSA) screening in the early 1990s, diagnosis and radical treatment of prostate cancer (PCa) has led to a 50% reduction in PCa-specific mortality since peak rates.[1]
Actuarial 13-year incidences of clinically significant prostate cancer diagnosis among participants with a baseline PSA of 0.49 ng/mL or less was 0.4%; 0.50-0.99 ng/mL, 1.5%; 1.00-1.99 ng/mL, 5.4%; 2.00-2.99 ng/mL, 10.6%; 3.00-3.99 ng/mL, 15.3%; and 4.00 ng/mL and greater, 29.5%
In this secondary analysis of a cohort from the PLCO Cancer Screening Trial, baseline PSA levels among men aged 55 to 60 years were associated with long-term risk of clinically significant prostate cancer
Summary
Since the introduction of widespread prostate-specific antigen (PSA) screening in the early 1990s, diagnosis and radical treatment of prostate cancer (PCa) has led to a 50% reduction in PCa-specific mortality since peak rates.[1] While PSA screening was once widely accepted and ubiquitous, opinions on the utility of screening have shifted in recent years, and there is controversy surrounding its use as a screening tool because of the overdiagnosis and overtreatment of indolent cancers.[2] The concern over the utility of PSA as a screening tool was highlighted by the United States Preventive Services Task Force recommendation against PSA screening in 2012,3 recently the task force has revised its statement to promote shared decision-making between patients and physicians.[4] This position has factored in the increased use of active surveillance for men with low-risk PCa, as defined by the American Urological Association.[5,6]. Until a more accurate biomarker is identified, PSA remains the best screening tool available for early PCa diagnosis. It is imperative to improve the detection of clinically significant PCa while minimizing overdiagnosis and overtreatment through a more nuanced approach to PSA screening
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