Determining optimal prostate-specific antigen thresholds to identify an increased 4-year risk of prostate cancer development: an analysis within the Veterans Affairs Health Care System

PURPOSE - To assess the prostate-specific antigen (PSA) threshold value that optimally predicts future risk of prostate cancer (overall and by race) for a dispersed US population.

METHODS - This was a retrospective analysis of men in the Veterans Affairs (VA) Health Care System database.

Men ≥ 40 years with a baseline PSA ≤ 4. 0 ng/mL, not receiving 5-alpha reductase inhibitors, and without a prostate cancer diagnosis prior to baseline PSA date were included and followed for 4 years. Patients diagnosed with prostate cancer within 6 months of baseline were excluded. The optimal PSA threshold value for future 4-year prostate cancer risk was determined by maximizing Youden's index.

RESULTS - The eligible population for the final analysis included 41,250 Caucasian (n = 24,518; 59. 4 %) and African American (n = 16,732; 40. 6 %) patients. The 4-year prostate cancer rate was 3. 08 % overall, and race-specific rates were 3. 02 and 3. 17 % for Caucasian and African American men, respectively. Mean time to prostate cancer diagnosis was 2. 01 years across all patients. Race-specific PSA thresholds that optimally predicted future prostate cancer were 2. 5 ng/mL [area under the curve (AUC) = 80. 3 %] in Caucasians and a 1. 9 ng/mL (AUC = 85. 4 %) in African Americans; across all patients, a 2. 4 ng/mL threshold was optimal (AUC = 82. 5 %).

CONCLUSIONS - In the VA population, a relatively low PSA threshold of ~2. 5 ng/mL was optimal in predicting prostate cancer within 4 years overall and for Caucasian men, but an even lower threshold of 1. 9 ng/mL was applicable for African American men.

World journal of urology. 2016 Jan 11 [Epub ahead of print]

S Scott Sutton, E David Crawford, Judd W Moul, James W Hardin, Eric Kruep

South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, 29208-0001, USA. University of Colorado Health Sciences Center, Denver, CO, USA. , Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA. , Dorn Research Institute, WJB Dorn Veterans Affairs Medical Center, Columbia, SC, USA. , Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.