Superiority of midlife baseline prostate-specific antigen value over PSA doubling time and velocity in the prediction of lethal prostate cancer development, and mortality: A system wide analysis of a racially diverse North American cohort

Document Type

Conference Proceeding

Publication Date

3-1-2024

Publication Title

Eur Urol

Abstract

Introduction & Objectives: Midlife baseline PSA (MB PSA), defined as a single PSA value measured between 40-59 years of age, has been proposed as a tool that can limit potential harms of PSA screening. We aimed to examine the ability of MB PSA vs PSA doubling time (PSADT) and PSA velocity (PSAV) in predicting development of lethal prostate cancer (PCa) in a diverse and contemporary North American population. Materials & Methods: Men aged 40–59 years, who received their first PSA between the years 1995 and 2019 were included. For MB PSA values, the first PSA test result was included. For PSADT, the first two PSA test results were included. For PSAV, the first three PSA test results within 30 months were included. Selection criteria resulted in a total of 78,625 patients with at least 2 PSA test results and 13,062 patients with at least 3 PSA test results. Multivariable Fine-Gray regression was used to examine the impact of the value of the PSA testing methods on the development of lethal PCa (defined as death from PCa or development of metastatic disease either at diagnosis or during follow-up). Time-dependent ROC/AUC curves at 5, 10, and 15 years were plotted. Results: In the main cohort, patients were most frequently in the 50–54 age category (32.8%), had a CCI of 0 (70.5%), and were white (63.2%). Of these, 9.3% had the midlife baseline PSA in the top 10th percentile, and 0.4% had a PSADT 0 – 6 months. Lethal PCa was diagnosed in 636 (0.8%) patients. The median (IQR) follow-up time was 11 (5.1 – 17.4) years. In the main cohort, MB PSA and PSADT were significant predictors for lethal PCa, with a HR 5.47 (95% CI: 4.40-6.78) and HR 2.81(95% CI: 1.45-5.45) for patients in the top 10th percentile MB PSA group and in the PSADT between 0-<6 months group, respectively. In patients with 3 PSA results available, MB PSA and PSAV were significant predictors for lethal PCa, with a HR 5.05 (95% CI: 3.16-8.06) and 3.26 (95% CI: 2.09-5.07) for patients in the top 10th percentile MB PSA group and in the in the PSAV > 0.4 ng/mL/year group, respectively. PSADT and PSAV did not have higher AUCs than MB PSA in predicting lethal PCa. Specifically, they were 0.712 and 0.639 at 10- and 15-year, respectively, for the PSADT; 0.749 and 0.708 at 10- and 15- year, respectively, for the PSAV and 0.840 and 0.750 at 10- and 15-year, respectively, for the MB PSA (all p> 0.05). Conclusions: PSAV or PSADT were not superior to midlife baseline PSA in predicting the development of lethal PCa. This suggests that these variables may not have practical utility in enhancing PSA screening strategies in a clinical setting.

Volume

85

First Page

S1615

Last Page

S1615

Find It @ Sladen

Share

COinS