Relationship Between Baseline Prostate-specific Antigen on Cancer Detection and Prostate Cancer Death: Long-term Follow-up from the European Randomized Study of Screening for Prostate Cancer.

The European Association of Urology guidelines recommend a risk-based strategy for prostate cancer screening based on the first prostate-specific antigen (PSA) level and age.

To analyze the impact of the first PSA level on prostate cancer (PCa) detection and PCa-specific mortality (PCSM) in a population-based screening trial (repeat screening every 2-4 yr).

We evaluated 25589 men aged 55-59 yr, 16898 men aged 60-64 yr, and 12936 men aged 65-69 yr who attended at least one screening visit in the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial (screening arm: repeat PSA testing every 2-4 yr and biopsy in cases with elevated PSA; control arm: no active screening offered) during 16-yr follow-up (FU).

We assessed the actuarial probability for any PCa and for clinically significant (cs)PCa (Gleason ≥7). Cox proportional-hazards regression was performed to assess whether the association between baseline PSA and PCSM was comparable for all age groups. A Lorenz curve was computed to assess the association between baseline PSA and PCSM for men aged 60-61 yr.

The overall actuarial probability at 16 yr ranged from 12% to 16% for any PCa and from 3.7% to 5.7% for csPCa across the age groups. The actuarial probability of csPCa at 16 yr ranged from 1.2-1.5% for men with PSA <1.0 ng/ml to 13.3-13.8% for men with PSA ≥3.0 ng/ml. The association between baseline PSA and PCSM differed marginally among the three age groups. A Lorenz curve for men aged 60-61 yr showed that 92% of lethal PCa cases occurred among those with PSA above the median (1.21 ng/ml). In addition, for men initially screened at age 60-61 yr with baseline PSA <2 ng/ml, further continuation of screening is unlikely to be beneficial after the age of 68-70 yr if PSA is still <2 ng/ml. No case of PCSM emerged in the subsequent 8 yr (up to age 76-78 yr). A limitation is that these results may not be generalizable to an opportunistic screening setting or to contemporary clinical practice.

In all age groups, baseline PSA can guide decisions on the repeat screening interval. Baseline PSA of <1.0 ng/ml for men aged 55-69 yr is a strong indicator to delay or stop further screening.

In prostate cancer screening, the patient's baseline PSA (prostate-specific antigen) level can be used to guide decisions on when to repeat screening. The PSA test when used according to current knowledge is valuable in helping to reduce the burden of prostate cancer.

European urology. 2023 Apr 21 [Epub ahead of print]

Sebastiaan Remmers, Chris H Bangma, Rebecka A Godtman, Sigrid V Carlsson, Anssi Auvinen, Teuvo L J Tammela, Louis J Denis, Vera Nelen, Arnauld Villers, Xavier Rebillard, Maciej Kwiatkowski, Franz Recker, Stephen Wyler, Marco Zappa, Donella Puliti, Giuseppe Gorini, Alvaro Paez, Marcos Lujan, Daan Nieboer, Fritz H Schröder, Monique J Roobol

Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands. Electronic address: ., Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Goteborg University, Goteborg, Sweden., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Goteborg University, Goteborg, Sweden; Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., School of Health Sciences, University of Tampere, Tampere, Finland., Department of Urology, Tampere University and Tampere University Hospital, Tampere, Finland., Department of Urology, Meeting Centre Antwerp, Antwerp, Belgium., Provincial Institute for Hygiene, Antwerp, Belgium., Department of Urology, Université Lille Nord de France, Lille, France., Department of Urology, Clinique Beau Soleil, Montpellier, France., Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland; Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany., PolyClinic St. Moritz/Scuol, Switzerland., Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland., Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy., Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain., Department of Urology, Hospital Infanta Cristina, Madrid, Spain., Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.