Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: Case-control study Journal Article


Authors: Vickers, A. J.; Cronin, A. M.; Björk, T.; Manjer, J.; Nilsson, P. M.; Dahlin, A.; Bjartell, A.; Scardino, P. T.; Ulmert, D.; Lilja, H.
Article Title: Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: Case-control study
Abstract: OBJECTIVE: To determine the relation between concentrations of prostate specific antigen at age 60 and subsequent diagnosis of clinically relevant prostate cancer in an unscreened population to evaluate whether screening for prostate cancer and chemoprevention could be stratified by risk. DESIGN: Case-control study with 1:3 matching nested within a highly representative population based cohort study. SETTING: General population of Sweden taking part in the Malmo Preventive Project. Cancer registry at the National Board of Health and Welfare. PARTICIPANTS: 1167 men aged 60 who provided blood samples in 1981 and were followed up to age 85. MAIN OUTCOME MEASURES: Metastasis or death from prostate cancer. RESULTS: The rate of screening during the course of the study was low. There were 43 cases of metastasis and 35 deaths from prostate cancer. Concentration of prostate specific antigen at age 60 was associated with prostate cancer metastasis (area under the curve 0.86, 95% confidence interval 0.79 to 0.92; P<0.001) and death from prostate cancer (0.90, 0.84 to 0.96; P<0.001). The greater the number for the area under the curve (values from 0 to 1) the better the test. Although only a minority of the men with concentrations in the top quarter (>2 ng/ml) develop fatal prostate cancer, 90% (78% to 100%) of deaths from prostate cancer occurred in these men. Conversely, men aged 60 with concentrations at the median or lower (≤1 ng/ml) were unlikely to have clinically relevant prostate cancer (0.5% risk of metastasis by age 85 and 0.2% risk of death from prostate cancer). CONCLUSIONS: The concentration of prostate specific antigen at age 60 predicts lifetime risk of metastasis and death from prostate cancer. Though men aged 60 with concentrations below the median (≤1 ng/ml) might harbour prostate cancer, it is unlikely to become life threatening. Such men could be exempted from further screening, which should instead focus on men with higher concentrations.
Keywords: aged; aged, 80 and over; middle aged; case control study; case-control studies; mortality; prostate specific antigen; metastasis; pathology; sweden; prostate-specific antigen; prostatic neoplasms; blood; register; registries; prostate tumor; reference values; neoplasm metastasis; age distribution; regression analysis; reference value
Journal Title: BMJ: British Medical Journal (International Edition)
Volume: 341
ISSN: 0959-8146
Publisher: BMJ Publishing Group Ltd.  
Date Published: 2010-09-14
Start Page: c4521
Language: English
DOI: 10.1136/bmj.c4521
PUBMED: 20843935
PROVIDER: scopus
PMCID: PMC2939950
DOI/URL:
Notes: --- - "Export Date: 20 April 2011" - "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. Angel M Cronin
    145 Cronin
  5. Hans David Staffan Ulmert
    49 Ulmert