PD38-09 FREE PSA AND CLINICALLY SIGNIFICANT AND FATAL PROSTATE CANCER IN THE PLCO SCREENING TRIAL

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You have accessJournal of UrologyCME1 Apr 2023PD38-09 FREE PSA AND CLINICALLY SIGNIFICANT AND FATAL PROSTATE CANCER IN THE PLCO SCREENING TRIAL Kendrick Yim, Chaoran Ma, Sigrid Carlsson, Hans Lilja, Vincent D'Andrea, Lorelei Mucci, Kathryn Penney, and Mark Preston Kendrick YimKendrick Yim More articles by this author , Chaoran MaChaoran Ma More articles by this author , Sigrid CarlssonSigrid Carlsson More articles by this author , Hans LiljaHans Lilja More articles by this author , Vincent D'AndreaVincent D'Andrea More articles by this author , Lorelei MucciLorelei Mucci More articles by this author , Kathryn PenneyKathryn Penney More articles by this author , and Mark PrestonMark Preston More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to determine if addition of free PSA (fPSA) to total PSA measured at baseline can improve prediction of clinically significant prostate cancer and fatal prostate cancer to guide risk-stratified screening. METHODS: Of the 27,451 men in the intervention arm of the PCLO cancer screening trial, 6162 had a total PSA and fPSA measured within 1 year of randomization (defined as baseline). Patients were stratified into two age groups: 57-64 and 65-72 years. Clinically significant prostate cancer (csPCa) was defined as Gleason Grade ≥7, AJCC Stage >3, metastatic disease, or PCa death. Cumulative incidence and Kaplan-Meier analyses were conducted to estimate the probability of csPCa and fatal PCa and area under the curve (AUC) for discrimination. RESULTS: Median follow up was 19 years during which 444 had csPCa and 92 had fatal PCa. Median PSA for overall cohort was 1.18 ng/mL, and median % fPSA was 18% at baseline. 75th percentile PSA levels were 3 ng/mL for ages 65-72 and 2 ng/mL for ages 57-64. In men 57-64 years with PSA ≥4 ng/mL and % fPSA >20%, the cumulative incidence (CI) of fatal PCa was 0.0/0.0% at 10/20 years and 2.1/3.0% for patients with % fPSA ≤20%. In men 65-72 years with PSA ≥5 ng/mL and % fPSA >20%, CI was 0.0/0.0% at 10/20 years and 1.4/6.3% for patients with % fPSA ≤20%. The predictive ability of total PSA for csPCa and fatal PCa was improved by adding % fPSA. In men 57-64 with PSA ≥2 ng/mL, AUC for fatal PCa increased from 0.55 to 0.69 by adding % fPSA and AUC for csPCa increased from 0.57 to 0.60. With PSA ≥3 ng/mL, AUC for fatal PCa increased from 0.41 to 0.65 with addition of % fPSA and AUC for csPCa increased from 0.57 to 0.64. In men 65-72 with PSA >4 ng/mL, AUC for fatal PCa increased from 0.63 to 0.65 by adding %fPSA and AUC for csPCa increased from 0.53 to 0.63. Kaplan-Meier curve (Figure 1) shows clear separation of curves for men with ≤20% fPSA compared to >20% fPSA in men with ≥75th percentile of total PSA at baseline. CONCLUSIONS: In a large nationwide screening trial, the addition of free PSA to total PSA in men with PSA >2 (age 57-64) or PSA>3 (age 65-72) improved the prediction of clinically significant and fatal prostate cancer. The use of free PSA to risk-stratify screening could potentially decrease unnecessary prostate biopsies and be used to help determine when to terminate screening. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e996 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kendrick Yim More articles by this author Chaoran Ma More articles by this author Sigrid Carlsson More articles by this author Hans Lilja More articles by this author Vincent D'Andrea More articles by this author Lorelei Mucci More articles by this author Kathryn Penney More articles by this author Mark Preston More articles by this author Expand All Advertisement PDF downloadLoading ...