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Developing new age-specific prostate-specific antigen thresholds for testing for prostate cancer

Research output: Contribution to journalArticle

Original languageEnglish
Number of pages6
JournalCancer Causes and Control
Early online date16 Feb 2018
DOIs
DateAccepted/In press - 9 Feb 2018
DateE-pub ahead of print (current) - 16 Feb 2018

Abstract

Purpose: To examine whether age-related reference ranges for “normal” prostate-specific antigen (PSA) change (determined in men without prostate cancer) can be used to identify men at high risk of having prostate cancer. Methods: Subjects were men aged 50–69 years with PSA < 10 ng/mL from the UK-based Prostate Testing for cancer and Treatment (ProtecT) study. Men with prostate cancer were categorized as high or low risk of progression (Low risk: Gleason score ≤ 6 and stage T1–T2a; High risk: Gleason score 7–10 or stage T2C). Men without prostate cancer were those with no histological confirmation of prostate cancer. Previously developed longitudinal reference ranges for normal age-related PSA change were used to calculate an age-specific PSA threshold. We compared the ability of our age-specific PSA threshold to discriminate between high- and no/low-risk prostate cancer with that of two existing thresholds: (i) threshold of PSA = 3 ng/ ml for all ages; (ii) National Institute of Clinical Excellence (NICE) guidelines dependent on age-group thresholds (age 50–59: PSA = 3 ng/mL; age 60–70: PSA = 4 ng/mL; age ≥ 70: PSA = 5 ng/mL). Results: We included 823 men with high-risk prostate cancer and 80,721 men with no/low-risk prostate cancer. A threshold of PSA = 3 ng/ml for all ages identified more high-risk prostate cancers, recommending biopsy in 9.8% of men, of which 10.3% (n = 823) had high-risk prostate cancer. Using the NICE guidelines as the threshold for biopsy, 6.9% men were recommended for biopsy, of which 11.9% (n = 668) had high-risk prostate cancer. Using the new age-specific threshold for biopsy, 2.3% men were recommended for biopsy, of which 15.2% (n = 290) had high-risk prostate cancer. The age-specific threshold identified fewer high-risk prostate cancers, but fewer men received unnecessary biopsy. Conclusion: There is no benefit to using reference ranges for “normal” PSA that change with age nor the age-specific thresholds suggested by the NICE guidelines. While the age-varying thresholds are more discriminatory, too many high-risk cancers are missed.

    Structured keywords

  • BRTC
  • Centre for Surgical Research

    Research areas

  • Prostate cancer, Prostate-specific antigen testing, Biopsy, Age, Reference ranges

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Springer at https://link.springer.com/article/10.1007%2Fs10552-018-1014-3 . Please refer to any applicable terms of use of the publisher.

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Springer at https://link.springer.com/article/10.1007%2Fs10552-018-1014-3 . Please refer to any applicable terms of use of the publisher.

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    Licence: CC BY

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