title: Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study.
abstract: OBJECTIVE
  To determine the association between concentration of prostate specific antigen (PSA) at age 40-55 and subsequent risk of prostate cancer metastasis and mortality in an unscreened population to evaluate when to start screening for prostate cancer and whether rescreening could be risk stratified.
  
  
  METHODS
  Case-control study with 1:3 matching nested within a highly representative population based cohort study.
  
  
  METHODS
  Malmö Preventive Project, Sweden.
  
  
  METHODS
  21,277 Swedish men aged 27-52 (74% of the eligible population) who provided blood at baseline in 1974-84, and 4922 men invited to provide a second sample six years later. Rates of PSA testing remained extremely low during median follow-up of 27 years.
  
  
  METHODS
  Metastasis or death from prostate cancer ascertained by review of case notes.
  
  
  RESULTS
  Risk of death from prostate cancer was associated with baseline PSA: 44% (95% confidence interval 34% to 53%) of deaths occurred in men with a PSA concentration in the highest 10th of the distribution of concentrations at age 45-49 (≥ 1.6 µg/L), with a similar proportion for the highest 10th at age 51-55 (≥ 2.4 µg/L: 44%, 32% to 56%). Although a 25-30 year risk of prostate cancer metastasis could not be ruled out by concentrations below the median at age 45-49 (0.68 µg/L) or 51-55 (0.85 µg/L), the 15 year risk remained low at 0.09% (0.03% to 0.23%) at age 45-49 and 0.28% (0.11% to 0.66%) at age 51-55, suggesting that longer intervals between screening would be appropriate in this group.
  
  
  CONCLUSIONS
  Measurement of PSA concentration in early midlife can identify a small group of men at increased risk of prostate cancer metastasis several decades later. Careful surveillance is warranted in these men. Given existing data on the risk of death by PSA concentration at age 60, these results suggest that three lifetime PSA tests (mid to late 40s, early 50s, and 60) are probably sufficient for at least half of men.
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Vickers
authors.forename: David
authors.initials: D
authors.lastname: Ulmert
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Sjoberg
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Bennette
authors.forename: Thomas
authors.initials: T
authors.lastname: Björk
authors.forename: Axel
authors.initials: A
authors.lastname: Gerdtsson
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nilsson
authors.forename: Anders
authors.initials: A
authors.lastname: Dahlin
authors.forename: Anders
authors.initials: A
authors.lastname: Bjartell
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: Hans
authors.initials: H
authors.lastname: Lilja
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013548:Sweden / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen