Prostate Specific Antigen At Or Before Age 50 As A Predictor Of Advanced Prostate Cancer Diagnosed Up To 25 Years Later: A Case-Control Study

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health;  Clinical Trials / Drug Trials
Article Date: 26 Apr 2008 - 0:00 PDT

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UroToday.com - Dr. Lilja and his group have previously shown that a single PSA measurement at or before age 50 is a strong predictor of prostate cancer (CaP) occurring up to 25 years later. In the online version of BMC Medicine, Dr. Ulmert leads an analysis from the group that supports that a single PSA measurement is also a very strong predictor of advanced CaP diagnosed up to 25 years later.

The study cohort was derived from the Malmö Preventive Medicine Study, a population-based study on cardiovascular risk factors that took place in Malmö, Sweden from 1974-1986. Men born between 1926 and 1949 participated in this study to primarily investigate risk factors for major cardiovascular and metabolic diseases. Blood plasma samples were archived at -20 and never thawed until this analysis. The Swedish Cancer Registry was to identify men diagnosed with CaP. A total of 21,277 men were in the Malmö Preventive Medicine database, and 498 (2.3%) were diagnosed with CaP. Blood samples were available for 462 of these men. Bone scan data was available on 370 of the 462 men (80%) and clinical stage was known for 398 (86%). A case-control nested design was used, with 2 to 3 controls without a diagnosis of CaP matched with cases for age and date of baseline venipuncture. The archived plasma was used to measure levels of total PSA, free PSA, and hK2. Complexed PSA was calculated.

Of the 161 men having advanced CaP, 62 had skeletal metastasis and 149 had at least T3 disease. Fifty patients had both. The median time from baseline venipuncture to diagnosis was 17 years and the median age at diagnosis was 64 years. WHO grade I, II, and III CaP was found in 18 men (11%), 73 men (45%), and 69 men (43%), respectively. Stage T3-4 was present in 93%, but most men did not have lymph nodes assessed. Patients with skeletal metastases or clinical stage T3 CaP had higher median levels of total PSA, complexed PSA, free PSA and hK2 and lower median free-to-total PSA ratios compared to men not diagnosed with CaP. An increase of 1ng/ml in total PSA was associated with an odds ratio for advanced cancer of 4.29. No additional markers added discriminative accuracy above that of total PSA alone. An increased total PSA level of 1.01-2ng/ml raised the odds more than 7-fold compared with a total PSA of 0.5ng/ml or less, and the odds increased 22-fold for a total PSA 2.01-3.0ng/ml. Patients with a total PSA of 2ng/ml had a risk of advanced CaP of 12%, more than 3-times the population mean. Forty-nine percent of the advanced cancers occurred among the 10% of subjects with the highest PSA levels, while 66% occurred among the top 20%.

Ulmert D, Cronin AM, Bjork T, O'Brien MF, Scardino PT, Eastham JA, Becker C, Berglund G, Vickers AJ, Lilja H

BMC Medicine 2008, 6(6) February 2008
doi:10.1186/1741-7015-6-6

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS Professor & Chairman Department of Urology University of California, Davis, School of Medicine Sacramento, CA

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