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. 2014 Mar;83(3):599-605.
doi: 10.1016/j.urology.2013.10.051. Epub 2014 Jan 16.

Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold

Roxanne Espaldon  1 , Katharine A Kirby  1 , Kathy Z Fung  1 , Richard M Hoffman  2 , Adam A Powell  3 , Stephen J Freedland  4 , Louise C Walter  5
Affiliations

Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold

Roxanne Espaldon et al. Urology. 2014 Mar.

Abstract

Objective: To determine the distribution of screening prostate-specific antigen (PSA) values in older men, and how different PSA thresholds affect the proportion of white, black, and Latino men who would have an abnormal screening result across advancing age groups.

Methods: We used linked national Veterans Affairs and Medicare data to determine the value of the first screening PSA test (ng/mL) of 327,284 men older than 65 years who underwent PSA screening in the Veterans Affairs health care system in 2003. We calculated the proportion of men with an abnormal PSA result based on age, race, and common PSA thresholds.

Results: Among men older than 65 years, 8.4% had a PSA >4.0 ng/mL. The percentage of men with a PSA >4.0 ng/mL increased with age and was highest in black men (13.8%) vs white (8.0%) or Latino men (10.0%) (P <.001). Combining age and race, the probability of having a PSA >4.0 ng/mL ranged from 5.1% of Latino men aged 65-69 years to 27.4% of black men older than 85 years. Raising the PSA threshold from >4.0 ng/mL to >10.0 ng/mL reclassified the greatest percentage of black men older than 85 years (18.3% absolute change) and the lowest percentage of Latino men aged 65-69 years (4.8% absolute change) as being under the biopsy threshold (P <.001).

Conclusion: Age, race, and PSA threshold together affect the pretest probability of an abnormal screening PSA result. Based on screening PSA distributions, stopping screening among men whose PSA <3 ng/mL means more than 80% of white and Latino men older than 70 years would stop further screening, and increasing the biopsy threshold to >10 ng/mL has the greatest effect on reducing the number of older black men who will face biopsy decisions after screening.

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Conflict of interest statement

The authors report no conflicts of interest related to the work described in this manuscript.

Figures

Figure 1
Figure 1
Exclusions used to define the final cohort of elderly men who received a screening PSA test in 2003 at a VA facility.
Figure 2
Figure 2
Percent of men with an Abnormal PSA Result Based on Age, Race, and PSA Threshold (N=327,284).
See this image and copyright information in PMC

Comment in

  • Editorial comment.
    Bahnson RR. Bahnson RR. Urology. 2014 Mar;83(3):605; discussion 605. doi: 10.1016/j.urology.2013.10.055. Epub 2014 Jan 16. Urology. 2014. PMID: 24439010 No abstract available.

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