Prostate Cancer Mortality in Men Aged 70 Years Who Recently Underwent Prostate-Specific Antigen Screening

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Continuing prostate-specific antigen (PSA) screening after age 70 may benefit select men at high risk for prostate cancer-specific mortality (PCSM) or metastatic prostate cancer (mPCa).
• The relative importance of clinical factors like race, ethnicity, competing mortality, and PSA history in identifying these high-risk men remains unclear.

Purpose of the Study:

• To evaluate the utility of PSA levels, race and ethnicity, and competing mortality in stratifying risk for PCSM and mPCa in men aged 70 years and older.
• To inform clinical decision-making regarding continued PSA screening in older men.

Main Methods:

• A cohort study analyzed clinical data from 921,609 men aged 70 years (2008-2020) within the Veterans Health Administration.
• Included men had a normal baseline PSA (<4 ng/mL) between ages 65-69 and no prior prostate cancer history.
• Risk stratification utilized PSA levels, race/ethnicity, and a machine learning-derived competing mortality risk score to predict 10-year PCSM and mPCa.

Main Results:

• Most men (87%) continued PSA screening past age 70, with little variation by risk factors.
• Higher baseline PSA levels (3.00-3.99 ng/mL) were associated with increased 10-year PCSM risk compared to lower levels (0.20-0.99 ng/mL).
• Baseline PSA <1 ng/mL demonstrated a very low 10-year risk of PCSM and mPCa, even in high-risk demographic groups.

Conclusions:

• The study suggests that most men continue PSA screening beyond age 70, despite generally low absolute 10-year PCSM risks.
• Pre-age 70 PSA levels are highly predictive of long-term outcomes, with PSA <1 ng/mL indicating very low risk for PCSM and mPCa.
• These findings support personalized screening strategies based on pre-70 PSA values.