title: Influence of blood prostate specific antigen levels at age 60 on benefits and harms of prostate cancer screening: population based cohort study.
abstract: OBJECTIVE
  To determine the relative risks of prostate cancer incidence, metastasis, and mortality associated with screening by serum prostate specific antigen (PSA) levels at age 60.
  
  
  METHODS
  Population based cohort study.
  
  
  METHODS
  General male population of Sweden taking part in a screening trial in Gothenburg or participating in a cardiovascular study, the Malmö Preventive Project.
  
  
  METHODS
  The screened group consisted of 1756 men aged 57.5-62.5 participating in the screening arm of the Gothenburg randomized prostate cancer screening trial since 1995. The unscreened group consisted of 1162 men, born in 1921, participating in the Malmö Preventive Project, with PSA levels measured retrospectively in stored blood samples from 1981.
  
  
  METHODS
  PSA screening versus no screening.
  
  
  METHODS
  Incidence rate ratios for the effect of screening on prostate cancer diagnosis, metastasis, and death by PSA levels at age 60.
  
  
  RESULTS
  The distribution of PSA levels was similar between the two cohorts. Differences in benefits by baseline PSA levels were large. Among men with baseline levels measured, 71.7% (1646/2295) had a PSA level <2 ng/mL. For men aged 60 with PSA level <2 ng/mL, there was an increase in incidence of 767 cases per 10,000 without a decrease in prostate cancer mortality. For men with PSA levels ≥ 2 ng/mL, the reduction in cancer mortality was large, with only 23 men needing to be screened and six diagnosed to avoid one prostate cancer death by 15 years.
  
  
  CONCLUSIONS
  The ratio of benefits to harms of PSA screening varies noticeably with blood PSA levels at age 60. For men with a PSA level <1 ng/mL at age 60, no further screening is recommended. Continuing to screen men with PSA levels >2 ng/mL at age 60 is beneficial, with the number needed to screen and treat being extremely favourable. Screening men with a PSA level of 1-2 ng/mL is an individual decision to be based on a discussion between patient and doctor.
authors.affiliation: Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Carlsson
authors.forename: Melissa
authors.initials: M
authors.lastname: Assel
authors.forename: Daniel
authors.initials: D
authors.lastname: Sjoberg
authors.forename: David
authors.initials: D
authors.lastname: Ulmert
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
authors.forename: Hans
authors.initials: H
authors.lastname: Lilja
authors.forename: Andrew
authors.initials: A
authors.lastname: Vickers
mesh_terms: D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000009:adverse effects / Q000706:statistics & numerical data; D008875:Middle Aged; D009362:Neoplasm Metastasis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D012306:Risk; D018570:Risk Assessment; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen