Prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate-specific antigen at or before age 50 Journal Article


Authors: Lilja, H.; Cronin, A. M.; Dahlin, A.; Manjer, J.; Nilsson, P. M.; Eastham, J. A.; Bjartell, A. S.; Scardino, P. T.; Ulmert, D.; Vickers, A. J.
Article Title: Prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate-specific antigen at or before age 50
Abstract: BACKGROUND: We previously reported that a single prostate-specific antigen (PSA) measured at ages 44-50 was highly predictive of subsequent prostate cancer diagnosis in an unscreened population. Here we report an additional 7 years of follow-up. This provides replication using an independent data set and allows estimates of the association between early PSA and subsequent advanced cancer (clinical stage ≥T3 or metastases at diagnosis). METHODS: Blood was collected from 21,277 men in a Swedish city (74% participation rate) during 1974-1986 at ages 33-50. Through 2006, prostate cancer was diagnosed in 1408 participants; we measured PSA in archived plasma for 1312 of these cases (93%) and for 3728 controls. RESULTS: At a median follow-up of 23 years, baseline PSA was strongly associated with subsequent prostate cancer (area under the curve, 0.72; 95% CI, 0.70-0.74; for advanced cancer, 0.75; 95% CI, 0.72-0.78). Associations between PSA and prostate cancer were virtually identical for the initial and replication data sets, with 81% of advanced cases (95% CI, 77%-86%) found in men with PSA above the median (0.63 ng/mL at ages 44-50). CONCLUSIONS: A single PSA at or before age 50 predicts advanced prostate cancer diagnosed up to 30 years later. Use of early PSA to stratify risk would allow a large group of low-risk men to be screened less often but increase frequency of testing on a more limited number of high-risk men. This is likely to improve the ratio of benefit to harm for screening. © 2010 American Cancer Society.
Keywords: adult; controlled study; middle aged; unclassified drug; major clinical study; case-control studies; advanced cancer; cancer staging; follow up; follow-up studies; cancer diagnosis; neoplasm staging; prostate specific antigen; blood chemical analysis; disease association; metastasis; risk factors; cancer screening; age factors; prediction; risk assessment; prostate cancer; sweden; prostate-specific antigen; prostatic neoplasms; antigen detection; carcinoma; kallikrein; high risk population; early detection of cancer; kallikrein related peptidase 2; predictive value; human kallikrein 2; case-control study
Journal Title: Cancer
Volume: 117
Issue: 6
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2011-03-15
Start Page: 1210
End Page: 1219
Language: English
DOI: 10.1002/cncr.25568
PUBMED: 20960520
PROVIDER: scopus
PMCID: PMC3412541
DOI/URL:
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 23 June 2011" - "CODEN: CANCA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Peter T Scardino
    621 Scardino
  2. Hans Gosta Lilja
    286 Lilja
  3. Andrew J Vickers
    556 Vickers
  4. Angel M Cronin
    145 Cronin
  5. James Eastham
    426 Eastham