Relative value of race, family history and prostate specific antigen as indications for early initiation of prostate cancer screening Journal Article


Authors: Vertosick, E. A.; Poon, B. Y.; Vickers, A. J.
Article Title: Relative value of race, family history and prostate specific antigen as indications for early initiation of prostate cancer screening
Abstract: Purpose Many guidelines suggest earlier screening for prostate cancer in men at high risk, with risk defined in terms of race and family history. Recent evidence suggests that baseline prostate specific antigen is strongly predictive of the long-term risk of aggressive prostate cancer. We compared the usefulness of risk stratifying early screening by race, family history and prostate specific antigen at age 45 years. Materials and Methods Using estimates from the literature we calculated the proportion of men targeted for early screening using family history, black race or prostate specific antigen as the criterion for high risk. We calculated the proportion of prostate cancer deaths that would occur in those men by age 75 years. Results Screening based on family history involved 10% of men, accounting for 14% of prostate cancer deaths. Using black race as a risk criterion involved 13% of men, accounting for 28% of deaths. In contrast, 44% of prostate cancer deaths occurred in the 10% of men with the highest prostate specific antigen at age 45 years. In no sensitivity analysis for race and family history did the ratio of risk group size to number of prostate cancer deaths in that risk group approach that of prostate specific antigen. Conclusions Basing decisions for early screening on prostate specific antigen at age 45 years provided the best ratio between men screened and potential cancer deaths avoided. Given the lack of evidence that race or family history affects the relationship between prostate specific antigen and risk, prostate specific antigen based risk stratification would likely include any black men or men with a family history who are destined to experience aggressive disease. Differential screening based on risk should be informed by baseline prostate specific antigen. © 2014 by American Urological Association Education and Research, Inc.
Keywords: adult; controlled study; middle aged; major clinical study; cancer risk; cancer incidence; prostate specific antigen; cancer screening; age factors; cancer mortality; groups by age; risk assessment; risk; prostate cancer; prostatic neoplasms; family history; african americans; african american; race; human; male; priority journal; article; black person; first degree relative
Journal Title: Journal of Urology
Volume: 192
Issue: 3
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2014-09-01
Start Page: 724
End Page: 728
Language: English
DOI: 10.1016/j.juro.2014.03.032
PROVIDER: scopus
PMCID: PMC4143426
PUBMED: 24641912
DOI/URL:
Notes: Export Date: 2 September 2014 -- CODEN: JOURA -- Source: Scopus
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MSK Authors
  1. Andrew J Vickers
    565 Vickers
  2. Jessica Bing Ying Poon
    15 Poon