The objective of this study is to examine whether a baseline calculation of PSAD is associated with prostate cancer-specific mortality after 30 years of follow-up.
One-thousand seven-hundred and seventy-nine men were screened for prostate cancer with a PSA test, digital rectal exam (DRE) and ultrasound of the prostate (TRUS). Outcomes, that is, prostate cancer-specific mortality, were extracted from the Swedish National Cause of Death Registry. Hazard ratios for cancer-specific deaths were estimated using Cox proportional hazard regression model. The area under the receiver operating curve (AUC) was determined using logistic regression for men with a baseline PSA in the interval between 3.0 and 10.0 ng/ml.
PSAD was available for 1748 men. Median PSAD was 0.095 ng/ml/cm3 (IQR 0.073-0.14). The age-adjusted hazard ratio for lethal prostate cancer in the cohort of men with PSA between 3.0 and 10.0 ng/ml was 10.1 (95% CI 2.4-42.2) if PSAD was ≥0.15 compared to <0.15.A model including PSAD, palpation and ultrasound findings could distinguish lethal prostate cancer from non-cases at 30 years of follow-up with an AUC of 0.75.
For men with PSA between 3 and 10 ng/ml, PSAD is a predictor of the long-term risk for lethal prostate cancer. One limitation to this study is the lack of clinical data during follow-up apart from cancer-specific mortality.
BJUI compass. 2026 Jul 10*** epublish ***
Sara Saliba, Anders Kjellman, Anna Thor, Ulf Norming, Anna Lantz, Ove Gustafsson, Per-Olof Lundgren
Department of Clinical Science, Technology and Intervention Karolinska Institute Stockholm Sweden., Karolinska Institute, Department of Clinical Science and Education Södersjukhuset Stockholm Sweden., Department of Urology Karolinska University Hospital Stockholm Sweden.