title: A "PSA pyramid" for men with initial prostate-specific antigen ≤3 ng/ml: a plea for individualized prostate cancer screening.
abstract: BACKGROUND
  In daily routine business, various prostate-specific antigen (PSA) retest strategies are being promoted.
  
  
  OBJECTIVE
  To investigate rescreening intervals according to baseline PSA <3 ng/ml stratified by any and aggressive prostate cancer (PCa).
  
  
  METHODS
  From 1998 to 2012, data from 4350 men aged 55-70 yr were analyzed from a population-based prospective screening study (median follow-up: 11.6 yr).
  
  
  METHODS
  The primary end point was detection of aggressive PCa (Gleason score 7-10). Cox regression analysis was used to examine the relationship between covariates.
  
  
  CONCLUSIONS
  Baseline PSA of <1.0 ng/ml, 1-1.9 ng/ml, and 2-2.9 ng/ml was present in 2416 men (55.5%: group 1), 1371 men (31.6%: group 2), and 563 men (12.9%: group 3), respectively. Stratified according to these PSA groups, aggressive PCa was detected in 25 patients (1.0%), 80 patients (5.8%), and 34 patients (6.0%), respectively. During 4 yr, these numbers were 0.0%, 0.29%, and 1.8%, whereas during 8 yr, the numbers were 0.2%, 1.4%, and 2.5%, respectively. In multivariable Cox regression analysis, the only independent risk factor for aggressive PCa was baseline PSA (hazard ratio [HR]: 6.06; 95% confidence interval [CI], 3.82-9.61; p<0.0001, group 2 vs group 1; and HR: 7.33; 95% CI, 4.29-12.52; p<0.0001, group 3 vs group 1).
  
  
  CONCLUSIONS
  Baseline PSA was the only predictor regarding aggressive PCa. According to the low rate of potentially missed PCa in these groups, rescreening intervals can be safely adapted to baseline PSA values corresponding to a "PSA pyramid": 6-8 yr if baseline PSA is <1.0 ng/ml, 3-4 yr if baseline PSA is 1-1.99 ng/ml, and yearly if baseline PSA is 2-2.99 ng/ml.
  
  
  RESULTS
  We observed men with a prostate-specific antigen (PSA) value ≤3 ng/ml during 12 yr and found that men can be retested according to their initial PSA value ("PSA pyramid"): PSA <1 (base), retest interval every 8 yr; PSA 1-2 (center), retest interval every 4 yr; and PSA 2-3 (top), retest yearly after risk stratification.
authors.affiliation: Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland. Electronic address: marco_randazzo1@hotmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Randazzo
authors.affiliation: Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Josef
authors.initials: J
authors.lastname: Beatrice
authors.affiliation: Department of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Huber
authors.affiliation: Department of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Rainer
authors.initials: R
authors.lastname: Grobholz
authors.affiliation: Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Manka
authors.affiliation: Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Felix K
authors.initials: FK
authors.lastname: Chun
authors.affiliation: Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Franz
authors.initials: F
authors.lastname: Recker
authors.affiliation: Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland; Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kwiatkowski
mesh_terms: D000368:Aged; D001706:Biopsy; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors; D015854:Up-Regulation
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Early detection; Prostate cancer; Screening; Screening interval; Survival