title: Men (aged 40-49 years) with a single baseline prostate-specific antigen below 1.0 ng/mL have a very low long-term risk of prostate cancer: results from a prospectively screened population cohort.
abstract: OBJECTIVE
  To study the use of a baseline prostate-specific antigen (PSA) and digital rectal examination in men (aged 40-49 years) in predicting long-term prostate cancer risk in a prospectively followed, representative population cohort.
  
  
  METHODS
  Since 1990, a random sample of men in Olmsted County (aged 40-49 years) has been followed up prospectively (n = 268), with biennial visits, including a urologic questionnaire, PSA screening, and physical examination. The ensuing risk of prostate cancer (CaP) was compared using survival analyses.
  
  
  RESULTS
  Median follow-up was 16.3 years (interquartile range 14.0-17.3, max 19.1). For men with a baseline PSA <1.0 ng/mL (n = 195), the risk of subsequent Gleason 6 CaP diagnosis by 55 years was 0.6% (95% confidence interval [CI] 0%-1.7%) and 15.7% (95% CI 6.5%-24.9%) for men with a baseline PSA ≥ 1.0 ng/mL. No man with a low baseline PSA developed an intermediate or high risk CaP, whereas 2.6% of men with a higher baseline PSA did (95% CI 0.58%-4.6%).
  
  
  CONCLUSIONS
  Men (aged 40-49 years) can be stratified with a baseline PSA. If it is below 1.0 ng/mL, there is very little risk for developing a lethal CaP, and as many as 75% of men might be able to avoid additional PSA screening until 55 years. Conversely, men aged 40-49 years with a baseline PSA level >1.0 ng/mL had a significant risk of CaP diagnosis and should be monitored more closely.
authors.affiliation: Department of Urology, University of Minnesota, MN. Electronic address: cjweight@umn.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Weight
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Jacobson
authors.forename: Michaela E
authors.initials: ME
authors.lastname: McGree
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
authors.forename: Jennifer
authors.initials: J
authors.lastname: St Sauver
mesh_terms: D000328:Adult; D015331:Cohort Studies; D051517:Digital Rectal Examination; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D012372:ROC Curve; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen