Age and PSA predict likelihood of organ-confined disease in men presenting with PSA less than 10 ng/ml: Implications for screening Journal Article

  

Authors:	Aleman, M.; Karakiewicz, P. I.; Kupelian, P.; Kattan, M. W.; Graefen, M.; Cagiannos, I.; Eastham, J.; Scardino, P. T.; Huland, H.; Klein, E. A.
Article Title:	Age and PSA predict likelihood of organ-confined disease in men presenting with PSA less than 10 ng/ml: Implications for screening
Abstract:	Objectives. To examine age and pretreatment prostate-specific antigen (PSA) level as predictors of organ-confined disease in a large multinational database of men with pretreatment PSA levels less than 10 ng/mL who were treated with radical prostatectomy. The optimal PSA and age cutoffs for triggering prostate biopsy are controversial. Although a PSA level greater than 4.0 ng/mL is generally accepted, recent observations suggest that PSA values between 2.5 and 4.0 ng/mL are associated with a 20% detection rate. Furthermore, age has been shown to represent an independent predictor of outcome after radical prostatectomy. Methods. We analyzed a cohort of 3198 patients from five institutions, who underwent radical prostatectomy between 1985 and 2001 for clinically localized prostate cancer. All presented with a pretreatment PSA level of less than 10 ng/mL. Multivariate analyses addressed age, preoperative PSA, year of treatment, biopsy Gleason sum, and clinical stage as independent predictors of non-organ-confined disease (NOCD). Results. Twenty-nine percent of patients had NOCD. All tested variables were independent, multivariate predictors of NOCD (age, P=0.004; year of treatment, P<0.0001; PSA, P<0.0001; Gleason sum, P<0.0001; clinical stage, P<0.0001). A linear relationship between age and the risk of NOCD was noted. The likelihood of NOCD remained constant for PSA levels between 0.1 and 4.0 ng/mL and rose substantially for PSA levels greater than 4.0 ng/mL. Conclusions. After controlling for other covariates, the rate of NOCD increased in proportion to age and pretreatment PSA level in men initially diagnosed with a serum PSA level less than 10 ng/mL These observations suggest that younger men with a lower PSA are more likely to have organ-confined and curable disease at diagnosis. This information has important implications for counseling and screening.
Keywords:	recurrence; prostate-specific antigen; detection; specificity; free survival; radical retropubic prostatectomy; extent; rates; level; cancer
Journal Title:	Urology
Volume:	62
Issue:	1
ISSN:	0090-4295
Publisher:	Elsevier Science, Inc.
Date Published:	2003-07-01
Start Page:	70
End Page:	74
Language:	English
ACCESSION:	WOS:000183892600018
DOI:	10.1016/s0090-4295(03)00125-0
PROVIDER:	wos
PUBMED:	12837425
Notes:	Article -- Source: Wos

https://synapse.mskcc.org/synapse/works/has_related_data_chk/61936