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miRNA Expression Analyses in Prostate Cancer Clinical Tissues
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Developing new age-specific prostate-specific antigen thresholds for testing for prostate cancer.

Rebecca Gilbert1, Kate Tilling2, Richard M Martin2,3

  • 1Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK. Becky.Gilbert@Bristol.ac.uk.

Cancer Causes & Control : CCC
|February 18, 2018
PubMed
Summary
This summary is machine-generated.

Age-specific prostate-specific antigen (PSA) thresholds do not improve prostate cancer risk identification. Current standard thresholds are more effective at detecting high-risk cancers than age-adjusted ones.

Keywords:
AgeBiopsyProstate cancerProstate-specific antigen testingReference ranges

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Area of Science:

  • Urology
  • Oncology
  • Medical Diagnostics

Background:

  • Prostate-specific antigen (PSA) is a biomarker used in prostate cancer screening.
  • Establishing accurate reference ranges for PSA is crucial for identifying men at high risk of prostate cancer.
  • Existing PSA thresholds vary by age, but their effectiveness in risk stratification requires further investigation.

Purpose of the Study:

  • To evaluate whether age-related reference ranges for normal prostate-specific antigen (PSA) levels can effectively identify men at high risk for prostate cancer.
  • To compare the efficacy of an age-specific PSA threshold against existing standard thresholds in discriminating high-risk prostate cancer.

Main Methods:

  • Analysis of data from the UK-based Prostate Testing for cancer and Treatment (ProtecT) study.
  • Inclusion of men aged 50-69 years with PSA < 10 ng/mL.
  • Categorization of prostate cancer patients into high-risk and low-risk progression groups based on Gleason score and tumor stage.
  • Calculation of an age-specific PSA threshold using previously developed longitudinal reference ranges.
  • Comparison of the new age-specific threshold with a universal PSA threshold of 3 ng/mL and National Institute of Clinical Excellence (NICE) age-group dependent thresholds.

Main Results:

  • The study included 823 men with high-risk prostate cancer and 80,721 men with no/low-risk prostate cancer.
  • A universal PSA threshold of 3 ng/mL identified more high-risk cancers but recommended biopsy for 9.8% of men.
  • NICE guidelines recommended biopsy for 6.9% of men, identifying 11.9% with high-risk cancer.
  • The new age-specific threshold recommended biopsy for only 2.3% of men, identifying 15.2% with high-risk cancer, but missed more high-risk cancers overall.

Conclusions:

  • Age-related reference ranges for normal PSA and age-specific thresholds do not offer a benefit in identifying men with high-risk prostate cancer.
  • While age-varying thresholds may be more discriminatory, they risk missing a significant number of high-risk cancers.
  • Current standard thresholds, particularly the PSA = 3 ng/mL threshold, appear more effective in detecting high-risk prostate cancer, despite recommending more biopsies.