Optimal screening interval for men with low baseline prostate-specific antigen levels (≤1.0ng/mL) in a prostate cancer screening program.

Abstract

To optimize the rescreening schedule for men with low baseline prostate-specific antigen (PSA) levels, we evaluated men with baseline PSA levels of ≤1.0ng/mL in PSA-based population screening. We enrolled 8086 men aged 55-69years with baseline PSA levels of ≤1.0ng/mL, who were screened annually. The relationships of baseline PSA and age with the cumulative risks and clinicopathological features of screening-detected cancer were investigated. Among the 8086 participants, 28 (0.35%) and 18 (0.22%) were diagnosed with prostate cancer and cancer with a Gleason score (GS) of ≥7 during the observation period, respectively. The cumulative probabilities of prostate cancer at 12years were 0.42, 1.0, 3.4, and 4.3% in men with baseline PSA levels of 0.0-0.4, 0.5-0.6, 0.7-0.8, and 0.9-1.0ng/mL, respectively. Those with GS of ≥7 had cumulative probabilities of 0.42, 0.73, 2.8, and 1.9%, respectively. The cumulative probabilities of prostate cancer were significantly lower when baseline PSA levels were 0.0-0.6ng/mL compared with 0.7-1.0ng/mL. Prostate cancer with a GS of ≥7 was not detected during the first 10years of screening when baseline PSA levels were 0.0-0.6ng/mL and was not detected during the first 2years when baseline PSA levels were 0.7-1.0ng/mL. Our study demonstrated that men with baseline PSA levels of 0.0-0.6ng/mL might benefit from longer screening intervals than those recommended in the guidelines of the Japanese Urological Association. Further investigation is needed to confirm the optimal screening interval for men with low baseline PSA levels.