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. 2008 Feb 15:6:6.
doi: 10.1186/1741-7015-6-6.

Prostate-specific antigen at or before age 50 as a predictor of advanced prostate cancer diagnosed up to 25 years later: a case-control study

David Ulmert  1 , Angel M Cronin, Thomas Björk, Matthew F O'Brien, Peter T Scardino, James A Eastham, Charlotte Becker, Göran Berglund, Andrew J Vickers, Hans Lilja
Affiliations

Prostate-specific antigen at or before age 50 as a predictor of advanced prostate cancer diagnosed up to 25 years later: a case-control study

David Ulmert et al. BMC Med. .

Abstract

Background: Based on a large, representative unscreened cohort from Malmö, Sweden, we have recently reported that a single prostate-specific antigen (PSA) measurement at or before age 50 is a strong predictor of prostate cancer occurring up to 25 years subsequently. We aimed to determine whether this association holds for advanced cancers, defined as clinical stage T3 or higher, or skeletal metastasis at the time of the cancer diagnosis.

Methods: In 1974-1986 blood samples were obtained from a cohort of 21,277 men aged up to 50. Through 1999, 498 men were diagnosed with prostate cancer, and of these 161 had locally advanced or metastatic prostate cancers. Three controls, matched for age and date of venipuncture, were selected for each case. Conditional logistic regression was used to test associations between molecular markers and advanced cancer.

Results: Median time from venipuncture to diagnosis was 17 years. Levels of all PSA forms and hK2 were associated with case status. Total PSA was a strong and statistically significant predictor of subsequent advanced cancer (area under the curve 0.791; p < 0.0005). Two-thirds of the advanced cancer cases occurred in men with the top 20% of PSA levels (0.9 ng/ml or higher).

Conclusion: A single PSA test taken at or before age 50 is a very strong predictor of advanced prostate cancer diagnosed up to 25 years later. This suggests the possibility of using an early PSA test to risk-stratify patients so that men at highest risk are the focus of the most intensive screening efforts.

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Figures

Figure 1
Figure 1
Box plot of total PSA, free-to-total PSA ratio and hK2 levels separately for cases of advanced cancer and controls.
Figure 2
Figure 2
Predicted probability of advanced prostate cancer by the total PSA level in anti-coagulated plasma measured at age 44–50. Dashed lines indicate the 95% CIs.
Figure 3
Figure 3
Predicted probability of advanced prostate cancer by population-based centiles of PSA measured at age 44–50. Dashed lines indicate the 95% CIs.
See this image and copyright information in PMC

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