Testing free PSA percentage as a tool in predicting future risk of developing prostate cancer: A system wide analysis of a contemporary North American cohort
Recommended Citation
Cirulli GO, Finati M, Chiarelli G, Stephens A, Davis M, Morrison C, Tinsley S, Etta P, Butaney M, Sood A, Lughezzani G, Buffi NM, Carrieri G, Salonia A, Briganti A, Montorsi F, Rogers CG, Abdollah F. Testing free PSA percentage as a tool in predicting future risk of developing prostate cancer: A system wide analysis of a contemporary North American cohort. Eur Urol 2024; 85:S435-S435.
Document Type
Conference Proceeding
Publication Date
3-1-2024
Publication Title
Eur Urol
Abstract
Introduction & Objectives: Free PSA percentage (%fPSA) has been proposed by International Guidelines as a useful serum marker in guiding biopsy decisions when further risk stratification is needed, especially in patients with mildly elevated PSA. On the other hand, it is not explicitly recommended to consider %fPSA as a tool to guide future PSA screening. We aimed to examine the potential role of %fPSA in predicting future development of PCa in a contemporary North American population. Materials & Methods: Men aged 40–59 years, who received their %fPSA between the years 1995 and 2019 were included. These selection criteria resulted in a total of 1,308 patients. Based on previously published methodology, Free PSA % was categorized in 3 different groups (< 10%, 10% to 25% and >25%). Main outcome was PCa incidence. Cumulative incidence curves were used to depict the risk of deveoloping PCa over time, based on %fPSA categories. Multivariable Fine-Gray regression was used to examine the role of %fPSA as a predictor of future development of PCa after adjusting for available confounders. Results: In our cohort, patients were most frequently in the 55–59 age category (33.4%), had a CCI of 0 (51.3%), and were white (75.6%). Most patients (68.8%) had a %fPSA between 10% and 25%. The median (IQR) follow-up time was 2.9 (0.9-5.1) years. Within this period, 228 (17.4%) patients, developed PCa. At 5-year the risk of developing PCa in patients with a %fPSA <10% vs10%-25% vs >25%, was 22.8% vs 8.9% vs 3.1%, respectively (p<0.001). On multivariable analysis, patients with a %fPSA <10%, had a 6.21-fold (95% CI: 3.62-10.64) higher risk of developing PCa when compared to those with a %fPSA >25% (p: <0.001). Conclusions: Our report is the first to examine the rule of %fPSA in the PSA screening context. Our findings showed that %fPSA measured in men without PCa is an important predictor of the future risk of developing PCa. This suggests that %fPSA has practical utility in enhancing PSA screening strategies in clinical practice, where patients with highest risk of developing PCa can receive more intense screening, and vice versa.
Volume
85
First Page
S435
Last Page
S435
