Research of the best screen interval for middle aged and elderly Chinese males with baseline prostate specific antigen levels <2.0 ng/mL in prostate cancer screening

Abstract

This study aimed to investigate the optimal screening interval of a prostate specific antigen (PSA) screening program for men aged 40–70 with a baseline PSA <2 ng/mL in China. 8-year period clinical data of Chinese males who underwent physical examination annually in our hospital were retrospectively collected. 397 healthy males were included.Total PSA (tPSA) and free PSA (fPSA) were collected, and the free/total PSA ratio (f/t PSA) was calculated. According to the baseline PSA value, study population was divided into 2 groups: 0–0.99 ng/mL and 1–1.99 ng/mL. Prostate biopsy indicates at tPSA >10 ng/mL, or 4–10 ng/mL (gray area) and f/t PSA <0.16. Kaplan-Meier survival analysis was used to calculate the relevant cumulative incidence rate. Over the eight-year screening period, 27 people (6.8%) had abnormal PSA that met prostate biopsy criteria. 7 cases of prostate cancer were detected (detection rate 25.9%) among the 27 patients who performed a biopsy. In the 0–0.99 ng/mL and 1–1.99 ng/mL group, 4.1% (13/317) and 17.5% (14/80) achieved biopsy criteria within 8 years, with a statistically significant difference (p < 0.001). In both groups, abnormal PSA began appearing in the sixth year. According to stratifying the cohort age and PSA, abnormal PSA levels began to appear in all subgroups by the sixth year, except for men aged <50 years plus baseline PSA <1 ng/mL, where they appeared by the seventh year. Furthermore, in the group of baseline 40–49 years and baseline PSA <2 ng/mL, the probability of meeting biopsy indications during eight years was very low (1.4%, 2/143). Chinese men aged 50–70 with baseline PSA <2 ng/mL should undergo for PSA retest in the sixth year, while aged 40–49 with a baseline PSA <2 ng/mL do not need PSA screening within eight years.