Prostate specific antigen changes as related to the initial prostate specific antigen: Data from the prostate, lung, colorectal and ovarian cancer screening trial

E. David Crawford, Paul F. Pinsky, David Chia, Barnett S. Kramer, Richard M. Fagerstrom, Gerald Andriole, Douglas Reding, Edward P. Gelmann, David L. Levin, John K. Gohagan

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Purpose: Annual screening with PSA, although of unproven benefit, is currently used for prostate cancer early detection. A large fraction of screened men have low (less than 2 ng/ml) initial PSA. The yield over time of positive PSA screens (ie more than 4 ng/ml) in these men has not been well characterized in large cohorts in the United States. Materials and Methods: Men in the screening arm of the PLCO received baseline PSA and annual tests for 5 years. 30,495 of these men had baseline PSA 4 ng/ml or less. We estimated the cumulative probability of converting to PSA greater than 4 at years 1 through 5 as a function of baseline PSA. Results: Among men with baseline PSA less than 1 ng/ml, 1.5% converted by year 5 (95% CI 1.2-1.7). Among men with baseline PSA of 1.0 to 1.99 ng/ml, 1.2% (95% CI 0.9-1.3) and 7.4% (95% CI 6.8-8.1) converted by year 1 and 5, respectively. A total of 33.5% and 79% of men with initial PSA of 2.0 to 2.99 and 3.0 to 4.0, respectively, converted by year 5. Of men with baseline PSA less than 1 ng/ml converting to PSA more than 4 ng/ml, 8% were diagnosed with cancer within 2 years of conversion. About 10% of men with baseline PSA less than 1 ng/ml and negative baseline DRE had a positive DRE within 3 years. Conclusions: For men choosing PSA screening, screening every 5 years for baseline PSA less than 1 ng/ml and every 2 years for PSA 1 to 2 ng/ml could result in a 50% reduction in PSA tests and in less than 1.5% of men missing earlier positive screens, but with an unknown effect on prostate cancer mortality.

Original languageEnglish (US)
Pages (from-to)1286-1290
Number of pages5
JournalJournal of Urology
Volume175
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

Keywords

  • Mass screening
  • Prostate-specific antigen
  • Prostatic neoplasms

ASJC Scopus subject areas

  • Urology

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