Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold.
OBJECTIVE
To determine the distribution of screening prostate-specific antigen (PSA) values in older men, and how different PSA thresholds affect the proportion of white, black, and Latino men who would have an abnormal screening result across advancing age groups.


METHODS
We used linked national Veterans Affairs and Medicare data to determine the value of the first screening PSA test (ng/mL) of 327,284 men older than 65 years who underwent PSA screening in the Veterans Affairs health care system in 2003. We calculated the proportion of men with an abnormal PSA result based on age, race, and common PSA thresholds.


RESULTS
Among men older than 65 years, 8.4% had a PSA >4.0 ng/mL. The percentage of men with a PSA >4.0 ng/mL increased with age and was highest in black men (13.8%) vs white (8.0%) or Latino men (10.0%) (P <.001). Combining age and race, the probability of having a PSA >4.0 ng/mL ranged from 5.1% of Latino men aged 65-69 years to 27.4% of black men older than 85 years. Raising the PSA threshold from >4.0 ng/mL to >10.0 ng/mL reclassified the greatest percentage of black men older than 85 years (18.3% absolute change) and the lowest percentage of Latino men aged 65-69 years (4.8% absolute change) as being under the biopsy threshold (P <.001).


CONCLUSIONS
Age, race, and PSA threshold together affect the pretest probability of an abnormal screening PSA result. Based on screening PSA distributions, stopping screening among men whose PSA <3 ng/mL means more than 80% of white and Latino men older than 70 years would stop further screening, and increasing the biopsy threshold to >10 ng/mL has the greatest effect on reducing the number of older black men who will face biopsy decisions after screening.
Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA.
Roxanne
R
Espaldon
Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA.
Katharine A
KA
Kirby
Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA.
Kathy Z
KZ
Fung
Department of Medicine, University of New Mexico, New Mexico VA Health Care System, Albuquerque, NM.
Richard M
RM
Hoffman
Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN.
Adam A
AA
Powell
Durham VA Medical Center, Durham, NC; Duke Prostate Center, Duke University, Durham, NC.
Stephen J
SJ
Freedland
Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA. Electronic address: Louise.Walter@ucsf.edu.
Louise C
LC
Walter
D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011336:Probability; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
D017430:Prostate-Specific Antigen