SAN DIEGO—Baseline PSA levels in men aged 55–60 years strongly predict the future risk of being diagnosed with prostate cancer (PCa), researchers reported at the American Urological Association's 2016 annual meeting.
For example, among men in this age group with a baseline PSA level less than 0.5 ng/mL, the 5- and 13-year risk of any PCa diagnosis is 0% and 0.8%, respectively, according to Eric Kovac, MD, of Cleveland Clinic Foundation and colleagues at Memorial Sloan-Kettering Cancer Center in New York and Göteborg University in Göteborg, Sweden. The risks of an important PCa diagnosis is 0% and 0.4%.
In contrast, among men with a baseline PSA level of 2.0–3.0 ng/mL, the 5- and 13-year risk of any PCa diagnosis is 8.4% and 24%, respectively. The corresponding risks of an important PCa diagnosis are 2.7% and 11%. The 5- and 13-year risks among men with a baseline PSA level greater than 4 ng/mL are 40.5% and 53.7%, respectively, for any PCa diagnosis and 21.3% and 29.5% for an important PCa diagnosis.
For the study, which included 10,968 men in the intervention arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) trial aged 55–60 years at study entry, Dr. Kovac and his colleagues defined an important PCa diagnosis as cT2b or higher or pT3 or higher tumors, biopsy or pathologic Gleason score of 7 or higher, or death from PCa. The median follow-up time from study enrollment to PCa diagnosis was 71 months, Dr. Kovac's group reported. The median survival time was 141 months. Only 15 men died from PCa after 13 years of follow-up. Eight of these men had a baseline PSA level above 4.0 ng/mL.
“Nomograms predicting the outcomes of screening should include baseline PSA information,” the investigators concluded in a poster presentation. “This information may be used to refine existing screening paradigms to reduce over-diagnosis and over-treatment.”