Initial PSA measurement can predict risk for prostate cancer death
MedWire News: A man's initial prostate-specific antigen (PSA) measurement can independently predict his risk for death from prostate cancer, show US study results.
"The results of the current study would appear to support a strategy of encouraging healthy men with a long life expectancy to obtain a baseline 'risk assessment' PSA at an early age to avoid a high baseline PSA level," write Judd Moul, from Duke University Medical Center in Durham, North Carolina, and colleagues.
The group investigated the relationship between baseline PSA and death from prostate cancer and death from all causes in a cohort of 4568 men with the disease, who had a median follow-up of 9.9 years from their baseline measurement.
The mean age of the men at baseline was 65.4 years, and their median PSA level was 36.3 ng/ml. Overall rates of death from prostate cancer and death from all causes were 3.5% and 20.2%, respectively, during follow-up.
Multivariate analysis revealed that men with a baseline PSA of 4.0-9.9 ng/ml were a significant 3.0 times more likely to die from prostate cancer compared with men with a baseline PSA of less than 2.5 ng/ml. Furthermore, men with a baseline PSA of 10.0 ng/ml or higher had a significant 11.5-fold increased risk for death from prostate cancer compared with a baseline of less than 2.5 ng/ml.
Being older at baseline PSA, and being African American rather than Caucasian were also associated with a higher rate of death from prostate cancer and death from all causes, report Moul et al in the journal Cancer.
In receiver operating characteristic analysis, the area under the curve for baseline PSA as a continuous variable in predicting death from prostate cancer was 0.839.
"This was high enough to warrant considering baseline PSA to be sufficiently sensitive and specific for predicting death from prostate cancer," note the researchers.
They add that when a baseline PSA of 10.0 ng/ml was chosen to predict death from prostate cancer, the corresponding sensitivity and specificity were 77% and 78%, respectively.
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By Sarah Guy