Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men.
OBJECTIVE
• To evaluate weather prostate-specific antigen (PSA) velocity could be used to stratify patients at risk of death from prostate cancer (PCa) and be useful in aiding decision making regarding PSA screening in elderly men, as previous studies have shown that PSA velocity can predict PCa risk.


METHODS
• The cohort included 3,525 patients aged ≥ 75 years with two or more PSA tests before a diagnosis of PCa. Cox proportional hazard model was used to evaluate which variables at time of last PSA measurement were associated with death from PCa. • The rates of death from PCa after diagnosis in different PSA velocity groups were calculated. Kaplan-Meier and log rank test were used to assess the significant difference in death from PCa after diagnosis, stratified by PSA velocity cutoff.


RESULTS
• On multivariate analysis, men with a PSA velocity of PSA velocity ≥ 0.45 ng/mL/year had a 4.8-fold higher risk of death from PCa as compared to men with a PSA velocity of < 0.45 ng/mL/year (p value = 0.013). After a median 6.5 (up to 16.9) years of follow-up from diagnosis, 1.4% of the men with a PSA velocity < 0.45 ng/mL/year had died of PCa as compared to 8.7% of those with a PSA velocity ≥ 0.45 ng/mL/year. • The cumulative rate of death from PCa after diagnosis, stratified by a PSA velocity of 0.45 ng/mL/year, was statistically different (log rank test, P < 0.001).


CONCLUSIONS
• Men age ≥ 75 years old with a PSA velocity of <0.45 ng/mL/year are unlikely to die of PCa. It may be safe to discontinue PSA screening in these men.
Division of Urology, Department of Surgery and Duke Prostate Center, Duke University Medical Center, Durham, NC, USA.
Ping
P
Tang
Leon
L
Sun
Matthew A
MA
Uhlman
Cary N
CN
Robertson
Thomas J
TJ
Polascik
Judd W
JW
Moul
D000368:Aged; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D013997:Time Factors; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data*
D017430:Prostate-Specific Antigen