Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: Case-control study Journal Article


Authors: Vickers, A. J.; Ulmert, D.; Sjoberg, D. D.; Bennette, C. J.; Björk, T.; Gerdtsson, A.; Manjer, J.; Nilsson, P. M.; Dahlin, A.; Bjartell, A.; Scardino, P. T.; Lilja, H.
Article Title: Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: Case-control study
Abstract: Objective To determine the association between concentration of prostate specific antigen (PSA) at age 40-55 and subsequent risk of prostate cancer metastasis and mortality in an unscreened population to evaluate when to start screening for prostate cancer and whether rescreening could be risk stratified. Design Case-control study with 1:3 matching nested within a highly representative population based cohort study. Setting Malmö Preventive Project, Sweden. Participants 21 277 Swedish men aged 27-52 (74% of the eligible population) who provided blood at baseline in 1974-84, and 4922 men invited to provide a second sample six years later. Rates of PSA testing remained extremely low during median follow-up of 27 years. Main outcome measures Metastasis or death from prostate cancer ascertained by review of case notes. Results Risk of death from prostate cancer was associated with baseline PSA: 44% (95% confidence interval 34% to 53%) of deaths occurred in men with a PSA concentration in the highest 10th of the distribution of concentrations at age 45-49 (≥1.6 μg/L), with a similar proportion for the highest 10th at age 51-55 (≥2.4 μg/L: 44%, 32% to 56%). Although a 25-30 year risk of prostate cancer metastasis could not be ruled out by concentrations below the median at age 45-49 (0.68 μg/L) or 51-55 (0.85 μg/L), the 15 year risk remained low at 0.09% (0.03% to 0.23%) at age 45-49 and 0.28% (0.11% to 0.66%) at age 51-55, suggesting that longer intervals between screening would be appropriate in this group. Conclusion Measurement of PSA concentration in early midlife can identify a small group of men at increased risk of prostate cancer metastasis several decades later. Careful surveillance is warranted in these men. Given existing data on the risk of death by PSA concentration at age 60, these results suggest that three lifetime PSA tests (mid to late 40s, early 50s, and 60) are probably sufficient for at least half of men.
Keywords: adult; controlled study; middle aged; retrospective studies; major clinical study; case control study; case-control studies; cancer risk; follow up; prostate specific antigen; metastasis; cohort analysis; cancer screening; mass screening; cancer mortality; risk assessment; prostate cancer; sweden; prostate-specific antigen; prostatic neoplasms; population research; neoplasm metastasis
Journal Title: BMJ: British Medical Journal (International Edition)
Volume: 346
Issue: 7907
ISSN: 0959-8146
Publisher: BMJ Publishing Group Ltd.  
Date Published: 2013-04-15
Start Page: f2023
Language: English
DOI: 10.1136/bmj.f2023
PUBMED: 23596126
PROVIDER: scopus
PMCID: PMC3933251
DOI/URL:
Notes: --- - "Export Date: 1 July 2013" - "CODEN: BMJOA" - "Source: Scopus"
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MSK Authors
  1. Peter T Scardino
    621 Scardino
  2. Hans Gosta Lilja
    286 Lilja
  3. Andrew J Vickers
    560 Vickers
  4. Daniel D. Sjoberg
    139 Sjoberg
  5. Hans David Staffan Ulmert
    49 Ulmert