Elsevier

Urology

Volume 58, Issue 3, September 2001, Pages 411-416
Urology

Adult urology: CME article
Low levels of prostate-specific antigen predict long-term risk of prostate cancer: results from the Baltimore Longitudinal Study of Aging

https://doi.org/10.1016/S0090-4295(01)01304-8Get rights and content

Abstract

Objectives. To evaluate the relationship between low prostate-specific antigen (PSA) levels that are considered normal and the long-term risk of prostate cancer.

Methods. The relative risk of, and cumulative probability of freedom from, prostate cancer by PSA level and age decade was evaluated in male participants of a longitudinal aging study, the Baltimore Longitudinal Study of Aging (National Institute on Aging). The relative risk was estimated from a Cox proportional hazards regression model for men aged 40 to 49.9 (n = 351) and 50 to 59.9 (n = 445). The disease-free probability was determined by Kaplan-Meier survival analysis.

Results. The relative risk of prostate cancer for men aged 40 to 49.9 was 3.75 (range 1.6 to 8.6) when the PSA level was at or greater than the median (0.60 ng/mL) compared with men with PSA levels less than the median. This risk was similar for men aged 50 to 59.9 when comparing those with PSA levels greater than and less than the median (0.71 ng/mL). At 25 years, the cumulative probability of freedom from prostate cancer for men aged 40 to 49.9 was 89.6% (range 81% to 97%) and 71.6% (range 60% to 83%) when the PSA level was less than and greater than the median, respectively. The 25-year disease-free probability for men aged 50 to 59.9 was 83.6% (range 76% to 91%) and 58.9% (range 48% to 70%) when the PSA level was less than and greater than the median, respectively.

Conclusions. The association between the baseline serum PSA level and the subsequent risk of prostate cancer suggests that the biologic events that predispose to prostate cancer begin early in middle age. Men who have baseline PSA levels that are “normal” but reflect a higher risk of prostate cancer may be the most appropriate candidates for future prevention trials. Those men with the lowest risk of prostate cancer on the basis of the baseline PSA measurements are unlikely to benefit from frequent PSA surveillance in an effort to detect prostate cancer early.

Section snippets

Study population

The Baltimore Longitudinal Study of Aging (BLSA) is an ongoing, long-term prospective study of aging conducted by the National Institute on Aging (Bethesda, Md), which has been previously described.7 Since the inception of the BLSA in 1958, a total of 1665 men and 1019 women have participated in the study for varying lengths of time. The participants in the study return for follow-up visits at approximately 2-year intervals.

Beginning in 1991, prostate cancer diagnoses were confirmed by

RR estimates

The subjects were divided into four evenly sized groups on the basis of the PSA quartiles (Table II). The PSA levels that defined the groups were 0.30, 0.59, and 0.90 ng/mL for men aged 40 to 49.9 and 0.40, 0.70, and 1.4 ng/mL for men aged 50 to 59.9. For men 40 to 49.9 years old with PSA levels of 0.6 to 0.9 ng/mL, the RR of prostate cancer was 7.9-fold (range 1.7 to 35.5) greater and was significantly different statistically from those men with PSA levels of 0.3 ng/mL or less. The RR was

Comment

We have shown, for the first time, the long-term risk of development of prostate cancer in young men during two to three decades as a function of the PSA level. The increased risk of prostate cancer in men aged 40 to 49.9 and 50 to 59.9 with the highest (albeit “normal”) baseline PSA levels becomes evident after 10 to 15 years of follow-up, and was surprisingly similar when the PSA levels were in either of the two quartiles above the median (Table II). Thus, young men with PSA levels around 1.0

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This study was supported by Prostate Spore NCI-CA58236, National Institute on Aging Intramural Research Program.

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