title: Age and PSA predict likelihood of organ-confined disease in men presenting with PSA less than 10 ng/mL: implications for screening.
abstract: OBJECTIVE
  To examine age and pretreatment prostate-specific antigen (PSA) level as predictors of organ-confined disease in a large multinational database of men with pretreatment PSA levels less than 10 ng/mL who were treated with radical prostatectomy. The optimal PSA and age cutoffs for triggering prostate biopsy are controversial. Although a PSA level greater than 4.0 ng/mL is generally accepted, recent observations suggest that PSA values between 2.5 and 4.0 ng/mL are associated with a 20% detection rate. Furthermore, age has been shown to represent an independent predictor of outcome after radical prostatectomy.
  
  
  METHODS
  We analyzed a cohort of 3198 patients from five institutions, who underwent radical prostatectomy between 1985 and 2001 for clinically localized prostate cancer. All presented with a pretreatment PSA level of less than 10 ng/mL. Multivariate analyses addressed age, preoperative PSA, year of treatment, biopsy Gleason sum, and clinical stage as independent predictors of non-organ-confined disease (NOCD).
  
  
  RESULTS
  Twenty-nine percent of patients had NOCD. All tested variables were independent, multivariate predictors of NOCD (age, P = 0.004; year of treatment, P <0.0001; PSA, P <0.0001; Gleason sum, P <0.0001; clinical stage, P <0.0001). A linear relationship between age and the risk of NOCD was noted. The likelihood of NOCD remained constant for PSA levels between 0.1 and 4.0 ng/mL and rose substantially for PSA levels greater than 4.0 ng/mL.
  
  
  CONCLUSIONS
  After controlling for other covariates, the rate of NOCD increased in proportion to age and pretreatment PSA level in men initially diagnosed with a serum PSA level less than 10 ng/mL. These observations suggest that younger men with a lower PSA are more likely to have organ-confined and curable disease at diagnosis. This information has important implications for counseling and screening.
authors.affiliation: Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Aleman
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Patrick
authors.initials: P
authors.lastname: Kupelian
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.forename: James
authors.initials: J
authors.lastname: Eastham
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen