Long-term Risk of Prostate Cancer Mortality Among Men with Baseline Prostate-specific Antigen Below 3 ng/ml: Evidence from the Finnish Randomized Study of Screening for Prostate Cancer
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View abstract on PubMed
Summary
This summary is machine-generated.Prostate cancer (PCa) mortality risk increases with initial PSA levels, particularly in younger men. Screening may be safely discontinued in older men (67-71 yr) with low PSA, suggesting a personalized approach to PCa screening.
Area Of Science
- Urology
- Oncology
- Public Health
Background
- Prostate-specific antigen (PSA) screening reduces prostate cancer (PCa) mortality.
- Optimal PSA cutoffs and the significance of low PSA levels for long-term PCa mortality prediction require further investigation.
Purpose Of The Study
- To assess PCa mortality in men with initial PSA levels below 3 ng/ml.
- To evaluate the relationship between low PSA levels and long-term PCa mortality in the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC).
Main Methods
- Retrospective cohort study of 20,268 men from the FinRSPC screening arm with initial PSA < 3 ng/ml.
- Follow-up up to 20 years with Cox regression analysis to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
Main Results
- PCa mortality was five-fold higher at PSA levels of 2-2.99 ng/ml compared to <1 ng/ml.
- The association between PSA and PCa mortality was stronger in younger men (55-58 yr) and for low-risk tumors.
- Adding cumulative PSA tests slightly improved PCa death prediction (C-statistic 0.683 to 0.717).
Conclusions
- A nuanced approach to PSA screening is important, considering combining PSA with other tests at low levels.
- Discontinuing screening at ages 67-71 yr with low PSA poses minimal risk.
- Findings suggest personalized screening strategies based on age and PSA levels.
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