Title

Baseline PSA levels in midlife & future development of lethal prostate cancer: A diverse North American cohort analysis

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

Find It @ Sladen

Share

COinS