MP39-13 BASELINE PROSTATE-SPECIFIC ANTIGEN (PSA) LEVELS IN MIDLIFE PREDICT TOTAL AND AGGRESSIVE PROSTATE CANCER IN AFRICAN-AMERICAN MEN

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2016MP39-13 BASELINE PROSTATE-SPECIFIC ANTIGEN (PSA) LEVELS IN MIDLIFE PREDICT TOTAL AND AGGRESSIVE PROSTATE CANCER IN AFRICAN-AMERICAN MEN Mark Preston, Kathryn Wilson, Travis Gerke, Sigrid Carlsson, Daniel Sjoberg, Adam Kibel, Quoc-Dien Trinh, Lisa Signorello, Mark Steinwandel, Andrew Vickers, Hans Lilja, and Lorelei Mucci Mark PrestonMark Preston More articles by this author , Kathryn WilsonKathryn Wilson More articles by this author , Travis GerkeTravis Gerke More articles by this author , Sigrid CarlssonSigrid Carlsson More articles by this author , Daniel SjobergDaniel Sjoberg More articles by this author , Adam KibelAdam Kibel More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Lisa SignorelloLisa Signorello More articles by this author , Mark SteinwandelMark Steinwandel More articles by this author , Andrew VickersAndrew Vickers More articles by this author , Hans LiljaHans Lilja More articles by this author , and Lorelei MucciLorelei Mucci More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.138AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate specific antigen (PSA) level in midlife predicts prostate cancer (PCa) mortality in Caucasian populations. It is poorly studied whether PSA measured during midlife predicts aggressive PCa among African-American men, a group for which PCa disparities exist. METHODS We performed a nested case-control study among African-American men age 40-65 years who gave blood at enrollment in the Southern Community Cohort Study between 2002-2009 and followed for median of 9 years. Baseline kallikrein levels (total PSA, free PSA, intact PSA, and human kallikrein 2 [hK2]) were measured in 197 PCa cases and 569 age-matched controls. 55 participants had aggressive disease defined as Gleason =4+3=7, AJCC Stage III or IV, or cancer-specific death. Exact conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between PSA and risk of total and aggressive PCa. Area under the curve (AUC) for prediction of total and aggressive disease by total PSA and a previously reported four-kallikrein risk score was calculated using logistic regression. RESULTS Median total PSA among the controls was 0.72, 0.80, 0.94, and 1.03 ng/mL for men age 40-49, 50-54 and 55-59, and 60-64 years, respectively. Risk of total PCa was strongly associated with baseline total PSA levels in midlife. Total PSA was also highly predictive of risk of aggressive disease. All 22 aggressive cases in men aged <55 years occurred among those with PSA above the age-specific median; among men 40-49 years, all 9 cases of aggressive disease were among those with PSA >90th percentile. Across age groups, the odds ratio of aggressive disease for PSA greater than the 90th percentile vs. less than the median was 38.8 (95% CI: 10.0-237), using age-specific cut-points. PSA-levels in midlife predicted total (AUC 0.88, 95% CI 0.85-0.91) and aggressive (AUC 0.87, 95% CI 0.81-0.92) prostate cancer with high discrimination. Among men with total PSA > 2 ng/ml, the four-kallikrein risk score improved prediction of aggressive disease compared to total PSA alone. CONCLUSIONS PSA level in midlife strongly predicted total and aggressive PCa in a cohort of African American men subject to opportunistic screening. These data provide further evidence for the utility of risk-stratified screening based on mid-life PSA. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e546 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Mark Preston More articles by this author Kathryn Wilson More articles by this author Travis Gerke More articles by this author Sigrid Carlsson More articles by this author Daniel Sjoberg More articles by this author Adam Kibel More articles by this author Quoc-Dien Trinh More articles by this author Lisa Signorello More articles by this author Mark Steinwandel More articles by this author Andrew Vickers More articles by this author Hans Lilja More articles by this author Lorelei Mucci More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...