Baseline PSA levels in midlife & future development of lethal prostate cancer: A diverse North American cohort analysis
Recommended Citation
Davis M, Stephens A, Morrison C, Majdalany S, Affas R, Arora S, Corsi N, Rakic I, Sood A, Rogers C, and Abdollah F. Baseline PSA levels in midlife & future development of lethal prostate cancer: A diverse North American cohort analysis. Eur Urol 2023; 83:S367.
Document Type
Conference Proceeding
Publication Date
2-1-2023
Publication Title
Eur Urol
Abstract
Introduction & Objectives: The aim of our study was to examine prostate cancer (PCa) mortality based on midlife prostate-specific antigen (PSA) results in a racially diverse North American population.
Materials & Methods: Our cohort included all men aged 40-59 years, who received their first PSA through our health system between the years 1995 and 2019. Next, patients were divided into 4 categories based on age as follows: 40 to 44, 45 to 49, 50 to 54, and 55 to 59 years. First PSA testing represented the main predictor of interest, and it was categorized based on median and 90th percentile for each age category. Fine-Gray regression was used to examine the impact of the value of PSA at first testing on the risk of developing lethal PCa (i.e. prostate cancer-specific mortality) after accounting for all confounders including race and comorbidity among others. Cancer-specific mortality and overall mortality were obtained by linking our database to the Michigan Vital Records registry.
Results: A total of 129,067 men met inclusion criteria during the study period, of which 82,084 (64%) were White, 30,883 (24%) were Black, and 16,100 (12%) were other race. Median and 90th percentile PSA were 0.7 and 2.0 ng/ml, respectively. For men aged 40 to 44, 45 to 49, 50 to 54, and 55 to 59 years, median PSA was respectively 0.6, 0.7, 0.7, and 0.9 ng/ml, and the 90th percentile PSA was respectively 1.4, 1.6, 2.1, and 3.0 ng/ml. For the same age categories, the estimated rate (95% CI) of lethal PCa at 20 years was 0.023% (0.003 - 0.130%), 0.14% (0.071 - 0.25%), 0.33% (0.19 - 0.54%), 0.51% (0.34 - 0.75%) in men with PSA < median, and 0.79% (0.22 - 2.2%), 0.16% (1.04 - 2.45%), 2.5% (1.80 - 3.35%), 5.4% (4.28 - 6.76%) in men with PSA ≥90th percentile. Median (IQR) follow-up was 7.8 (3.2 - 15.0) years. On multivariable analysis, men with a PSA≥90th percentile had a 11.57 HR (95% CI: 8.71 - 15.35) times higher risk of developing lethal PCa, when compared to those with PSA < median at first testing. This HR (95% CI) was 11.03 (2.01 - 60.57), 13.96 (6.93 - 28.13), 13.01 (7.62 - 22.23), and 10.47 (7.09 - 15.47) for men aged 40 to 44, 45 to 49, 50 to 54, and 55 to 59 years, respectively.
Conclusions: Our findings suggest that midlife first-time PSA is an important predictor of the subsequent risk of developing lethal PCa. This information can be used to develop a PSA screening program, which is tailored to the patient's specific risk. To the best of our knowledge, our report is the first to examine the role of first-time PSA in a diverse North American cohort.
Volume
83
First Page
S367
