title: Relative value of race, family history and prostate specific antigen as indications for early initiation of prostate cancer screening.
abstract: OBJECTIVE
  Many guidelines suggest earlier screening for prostate cancer in men at high risk, with risk defined in terms of race and family history. Recent evidence suggests that baseline prostate specific antigen is strongly predictive of the long-term risk of aggressive prostate cancer. We compared the usefulness of risk stratifying early screening by race, family history and prostate specific antigen at age 45 years.
  
  
  METHODS
  Using estimates from the literature we calculated the proportion of men targeted for early screening using family history, black race or prostate specific antigen as the criterion for high risk. We calculated the proportion of prostate cancer deaths that would occur in those men by age 75 years.
  
  
  RESULTS
  Screening based on family history involved 10% of men, accounting for 14% of prostate cancer deaths. Using black race as a risk criterion involved 13% of men, accounting for 28% of deaths. In contrast, 44% of prostate cancer deaths occurred in the 10% of men with the highest prostate specific antigen at age 45 years. In no sensitivity analysis for race and family history did the ratio of risk group size to number of prostate cancer deaths in that risk group approach that of prostate specific antigen.
  
  
  CONCLUSIONS
  Basing decisions for early screening on prostate specific antigen at age 45 years provided the best ratio between men screened and potential cancer deaths avoided. Given the lack of evidence that race or family history affects the relationship between prostate specific antigen and risk, prostate specific antigen based risk stratification would likely include any black men or men with a family history who are destined to experience aggressive disease. Differential screening based on risk should be informed by baseline prostate specific antigen.
authors.affiliation: Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Vertosick
authors.affiliation: Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Bing Ying
authors.initials: BY
authors.lastname: Poon
authors.affiliation: Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: vickersa@mskcc.org.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Vickers
mesh_terms: D001741:Black or African American; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000235:genetics; D018570:Risk Assessment
chemical_list: D017430:Prostate-Specific Antigen
keywords: African Americans; age factors; prostate specific antigen; prostatic neoplasms; risk