Prostate-specific antigen and long-term prediction of prostate cancer incidence and mortality in the general population

David D Orsted; Børge G Nordestgaard; Gorm B Jensen; Peter Schnohr; Stig E Bojesen; David Dynnes Ørsted

doi:10.1016/j.eururo.2011.11.007

Prostate-specific antigen and long-term prediction of prostate cancer incidence and mortality in the general population

David D Orsted, Børge G Nordestgaard, Gorm B Jensen, Peter Schnohr, Stig E Bojesen, David Dynnes Ørsted

35 Citations (Scopus)

Abstract

Background: It is largely unknown whether prostate-specific antigen (PSA) level at first date of testing predicts long-term risk of prostate cancer (PCa) incidence and mortality in the general population. Objective: Determine whether baseline PSA levels predict long-term risk of PCa incidence and mortality. Design, setting, and participants: We examined 4383 men aged 20-94 yr from the Danish general population in the prospective Copenhagen City Heart Study. PSA was measured in plasma samples obtained in 1981-1983. Measurements: PCa incidence and mortality as a function of baseline PSA was assessed using Kaplan-Meier plots of cumulative incidence and competing risk subhazard ratios. Results and limitations: During 28 yr of follow-up, 170 men developed PCa, and 94 men died from PCa. Median follow-up was 18 yr (range: 0.5-28 yr). For PCa incidence, the subhazard ratio was 3.0 (95% confidence interval [CI], 1.9-4.6) for a PSA level of 1.01-2.00 ng/ml, 6.8 (95% CI, 4.2-11) for PSA 2.01-3.00 ng/ml, 6.6 (95% CI, 3.4-13) for PSA 3.01-4.00 ng/ml, 16 (95% CI, 10.4-25) for PSA 4.01-10.00 ng/ml, and 57 (95% CI, 32-104) for PSA >10.00 ng/ml versus 0.01-1.00 ng/ml. For PCa mortality, corresponding subhazard ratios were 2.2 (95% CI, 1.3-3.9), 5.1 (95% CI, 2.8-9.0), 4.2 (95% CI, 1.8-10), 7.0 (95% CI, 3.8-14), and 14 (95% CI, 6.0-32). For men with PSA levels of 0.01-1.00 ng/ml, the absolute 10-yr risk of PCa was 0.6% for ages <45 yr, 0.7% for ages 45-49 yr, 1.1% for ages 50-54 yr, 1.2% for ages 55-59 yr, 1.3% for ages 60-64 yr, 1.1% for ages 65-69 yr, 1.3% for ages 70-74 yr, and 1.5% for ages ≥75 yr; corresponding values for PSA levels >10.00 ng/ml were 35%, 41%, 63%, 71%, 77%, 69%, 75%, and 88%, respectively. Conclusions: Stepwise increases in PSA at first date of testing predicted a 3-57-fold increased risk of PCa, a 2-16-fold increased risk of PCa mortality, and a 35-88% absolute 10-yr risk of PCa in men with PSA levels >10.00 ng/ml. Equally important, the absolute 10-yr risk of PCa in men with PSA levels 0.01-1.00 ng/ml was only 0.6-1.5%.

Original language	English
Journal	European Urology
Volume	61
Issue number	5
Pages (from-to)	865-74
Number of pages	10
ISSN	0302-2838
DOIs	https://doi.org/10.1016/j.eururo.2011.11.007
Publication status	Published - May 2012

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10.1016/j.eururo.2011.11.007

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@article{7118e84991734f60bfe64b2d6d708e6d,

title = "Prostate-specific antigen and long-term prediction of prostate cancer incidence and mortality in the general population",

abstract = "Background: It is largely unknown whether prostate-specific antigen (PSA) level at first date of testing predicts long-term risk of prostate cancer (PCa) incidence and mortality in the general population. Objective: Determine whether baseline PSA levels predict long-term risk of PCa incidence and mortality. Design, setting, and participants: We examined 4383 men aged 20-94 yr from the Danish general population in the prospective Copenhagen City Heart Study. PSA was measured in plasma samples obtained in 1981-1983. Measurements: PCa incidence and mortality as a function of baseline PSA was assessed using Kaplan-Meier plots of cumulative incidence and competing risk subhazard ratios. Results and limitations: During 28 yr of follow-up, 170 men developed PCa, and 94 men died from PCa. Median follow-up was 18 yr (range: 0.5-28 yr). For PCa incidence, the subhazard ratio was 3.0 (95% confidence interval [CI], 1.9-4.6) for a PSA level of 1.01-2.00 ng/ml, 6.8 (95% CI, 4.2-11) for PSA 2.01-3.00 ng/ml, 6.6 (95% CI, 3.4-13) for PSA 3.01-4.00 ng/ml, 16 (95% CI, 10.4-25) for PSA 4.01-10.00 ng/ml, and 57 (95% CI, 32-104) for PSA >10.00 ng/ml versus 0.01-1.00 ng/ml. For PCa mortality, corresponding subhazard ratios were 2.2 (95% CI, 1.3-3.9), 5.1 (95% CI, 2.8-9.0), 4.2 (95% CI, 1.8-10), 7.0 (95% CI, 3.8-14), and 14 (95% CI, 6.0-32). For men with PSA levels of 0.01-1.00 ng/ml, the absolute 10-yr risk of PCa was 0.6% for ages <45 yr, 0.7% for ages 45-49 yr, 1.1% for ages 50-54 yr, 1.2% for ages 55-59 yr, 1.3% for ages 60-64 yr, 1.1% for ages 65-69 yr, 1.3% for ages 70-74 yr, and 1.5% for ages ≥75 yr; corresponding values for PSA levels >10.00 ng/ml were 35%, 41%, 63%, 71%, 77%, 69%, 75%, and 88%, respectively. Conclusions: Stepwise increases in PSA at first date of testing predicted a 3-57-fold increased risk of PCa, a 2-16-fold increased risk of PCa mortality, and a 35-88% absolute 10-yr risk of PCa in men with PSA levels >10.00 ng/ml. Equally important, the absolute 10-yr risk of PCa in men with PSA levels 0.01-1.00 ng/ml was only 0.6-1.5%.",

author = "Orsted, {David D} and Nordestgaard, {B{\o}rge G} and Jensen, {Gorm B} and Peter Schnohr and Bojesen, {Stig E} and {\O}rsted, {David Dynnes}",

year = "2012",

month = may,

doi = "10.1016/j.eururo.2011.11.007",

language = "English",

volume = "61",

pages = "865--74",

journal = "European Urology",

issn = "0302-2838",

publisher = "Elsevier",

number = "5",

}

TY - JOUR

T1 - Prostate-specific antigen and long-term prediction of prostate cancer incidence and mortality in the general population

AU - Orsted, David D

AU - Nordestgaard, Børge G

AU - Jensen, Gorm B

AU - Schnohr, Peter

AU - Bojesen, Stig E

AU - Ørsted, David Dynnes

PY - 2012/5

Y1 - 2012/5

N2 - Background: It is largely unknown whether prostate-specific antigen (PSA) level at first date of testing predicts long-term risk of prostate cancer (PCa) incidence and mortality in the general population. Objective: Determine whether baseline PSA levels predict long-term risk of PCa incidence and mortality. Design, setting, and participants: We examined 4383 men aged 20-94 yr from the Danish general population in the prospective Copenhagen City Heart Study. PSA was measured in plasma samples obtained in 1981-1983. Measurements: PCa incidence and mortality as a function of baseline PSA was assessed using Kaplan-Meier plots of cumulative incidence and competing risk subhazard ratios. Results and limitations: During 28 yr of follow-up, 170 men developed PCa, and 94 men died from PCa. Median follow-up was 18 yr (range: 0.5-28 yr). For PCa incidence, the subhazard ratio was 3.0 (95% confidence interval [CI], 1.9-4.6) for a PSA level of 1.01-2.00 ng/ml, 6.8 (95% CI, 4.2-11) for PSA 2.01-3.00 ng/ml, 6.6 (95% CI, 3.4-13) for PSA 3.01-4.00 ng/ml, 16 (95% CI, 10.4-25) for PSA 4.01-10.00 ng/ml, and 57 (95% CI, 32-104) for PSA >10.00 ng/ml versus 0.01-1.00 ng/ml. For PCa mortality, corresponding subhazard ratios were 2.2 (95% CI, 1.3-3.9), 5.1 (95% CI, 2.8-9.0), 4.2 (95% CI, 1.8-10), 7.0 (95% CI, 3.8-14), and 14 (95% CI, 6.0-32). For men with PSA levels of 0.01-1.00 ng/ml, the absolute 10-yr risk of PCa was 0.6% for ages <45 yr, 0.7% for ages 45-49 yr, 1.1% for ages 50-54 yr, 1.2% for ages 55-59 yr, 1.3% for ages 60-64 yr, 1.1% for ages 65-69 yr, 1.3% for ages 70-74 yr, and 1.5% for ages ≥75 yr; corresponding values for PSA levels >10.00 ng/ml were 35%, 41%, 63%, 71%, 77%, 69%, 75%, and 88%, respectively. Conclusions: Stepwise increases in PSA at first date of testing predicted a 3-57-fold increased risk of PCa, a 2-16-fold increased risk of PCa mortality, and a 35-88% absolute 10-yr risk of PCa in men with PSA levels >10.00 ng/ml. Equally important, the absolute 10-yr risk of PCa in men with PSA levels 0.01-1.00 ng/ml was only 0.6-1.5%.

AB - Background: It is largely unknown whether prostate-specific antigen (PSA) level at first date of testing predicts long-term risk of prostate cancer (PCa) incidence and mortality in the general population. Objective: Determine whether baseline PSA levels predict long-term risk of PCa incidence and mortality. Design, setting, and participants: We examined 4383 men aged 20-94 yr from the Danish general population in the prospective Copenhagen City Heart Study. PSA was measured in plasma samples obtained in 1981-1983. Measurements: PCa incidence and mortality as a function of baseline PSA was assessed using Kaplan-Meier plots of cumulative incidence and competing risk subhazard ratios. Results and limitations: During 28 yr of follow-up, 170 men developed PCa, and 94 men died from PCa. Median follow-up was 18 yr (range: 0.5-28 yr). For PCa incidence, the subhazard ratio was 3.0 (95% confidence interval [CI], 1.9-4.6) for a PSA level of 1.01-2.00 ng/ml, 6.8 (95% CI, 4.2-11) for PSA 2.01-3.00 ng/ml, 6.6 (95% CI, 3.4-13) for PSA 3.01-4.00 ng/ml, 16 (95% CI, 10.4-25) for PSA 4.01-10.00 ng/ml, and 57 (95% CI, 32-104) for PSA >10.00 ng/ml versus 0.01-1.00 ng/ml. For PCa mortality, corresponding subhazard ratios were 2.2 (95% CI, 1.3-3.9), 5.1 (95% CI, 2.8-9.0), 4.2 (95% CI, 1.8-10), 7.0 (95% CI, 3.8-14), and 14 (95% CI, 6.0-32). For men with PSA levels of 0.01-1.00 ng/ml, the absolute 10-yr risk of PCa was 0.6% for ages <45 yr, 0.7% for ages 45-49 yr, 1.1% for ages 50-54 yr, 1.2% for ages 55-59 yr, 1.3% for ages 60-64 yr, 1.1% for ages 65-69 yr, 1.3% for ages 70-74 yr, and 1.5% for ages ≥75 yr; corresponding values for PSA levels >10.00 ng/ml were 35%, 41%, 63%, 71%, 77%, 69%, 75%, and 88%, respectively. Conclusions: Stepwise increases in PSA at first date of testing predicted a 3-57-fold increased risk of PCa, a 2-16-fold increased risk of PCa mortality, and a 35-88% absolute 10-yr risk of PCa in men with PSA levels >10.00 ng/ml. Equally important, the absolute 10-yr risk of PCa in men with PSA levels 0.01-1.00 ng/ml was only 0.6-1.5%.

U2 - 10.1016/j.eururo.2011.11.007

DO - 10.1016/j.eururo.2011.11.007

M3 - Journal article

C2 - 22104593

SN - 0302-2838

VL - 61

SP - 865

EP - 874

JO - European Urology

JF - European Urology

IS - 5

ER -

Prostate-specific antigen and long-term prediction of prostate cancer incidence and mortality in the general population

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