Long-term, PSA-based risk for prostate cancer


In September last year we provided information about a Danish study by Orsted et al. on the use of PSA levels in projecting the long-term risk of prostate cancer that had been presented at a scientific meeting in Europe.

The full, peer-reviewed report from this study has now been published in European Urology.

PSA data were obtained from plasma samples from 4,383 men aged between 20 and 94 years enrolled in the prospective Copenhagen City Heart Study. (The plasma samples were all obtained in the period 1981-83.) Orsted et al. were then able to correlate these data with the real incidence of prostate cancer and the rate of prostate cancer-specific mortality among these 4,383 men over the ensuing 28 years of follow-up, with the following detailed results:

  • The average (median) follow-up was 18 years (range, 0.5 to 28 years).
  • 170 men were diagnosed with prostate cancer.
  • 94 men died from prostate cancer.
  • For men with PSA levels of 0.01-1.00 ng/ml, the absolute 10-yr risk of prostate cancer was
    • 0.6 percent for men of < 45 years
    • 0.7 percent for men of 45-49 years
    • 1.1 percent for men of 50-54 years
    • 1.2 percent for men of 55-59 years
    • 1.3 percent for men of 60-64 years
    • 1.1 percent for men of 65-69 years
    • 1.3 percent for men of 70-74 years
    • 1.5 percent for men of ≥75 years
  • For men with PSA levels >10.00 ng/ml, the absolute 10-year risk of prostate cancer was
    • 35 percent for men of < 45 years
    • 41 percent for men of 45-49 years
    • 63 percent for men of 50-54 years
    • 71 percent for men of 55-59 years
    • 77 percent for men of 60-64 years
    • 69 percent for men of 65-69 years
    • 75 percent for men of 70-74 years
    • 88 percent for men of ≥75 years
  • Compared to the risk among men with a PSA level of 0.01-1.00 ng/ml, the hazard ratios for diagnosis of prostate cancer were
    • 3.0 for men with a PSA level of  1.01-2.00 ng/ml
    • 6.8 for men with a PSAlevel of 2.01-3.00 ng/ml
    • 6.6 for men with a PSA level of 3.01-4.00 ng/ml
    • 16 for men with a PSA level of 4.01-10.00 ng/ml
    • 57 for men with a PSA level of >10.00 ng/ml
  • Compared to the risk among men with a PSA level of 0.01-1.00 ng/ml, the hazard ratios for prostate cancer-specific mortality were
    • 2.2 for men with a PSA level of  1.01-2.00 ng/ml
    • 5.1 for men with a PSAlevel of 2.01-3.00 ng/ml
    • 4.2 for men with a PSA level of 3.01-4.00 ng/ml
    • 7.0 for men with a PSA level of 4.01-10.00 ng/ml
    • 14 for men with a PSA level of >10.00 ng/ml

This study appears to provide substantial evidence for the idea originally proposed by Vickers and Lilja that a baseline PSA level can accurately project long-term risk for prostate cancer, thus allowing us to identify subsets of men who do and don’t need careful monitoring for risk over time (see last Wednesday’s commentary on this issue).

2 Responses

  1. PSA data were obtained from plasma samples from 4,383 men aged between 20 and 94 years…

    and

    The average (median) follow-up was 18 years (range, 0.5 to 28 years).

    What are the odds that the 6 month follow-up related to the 94 year old man?

  2. I’ll have to ask the ACS’s statisticians.

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