title: Population-based assessment of prostate-specific antigen testing for prostate cancer in the elderly.
abstract: OBJECTIVE
  To perform a population-based analysis to characterize the effect of prostate-specific antigen (PSA) testing on oncologic outcomes in men diagnosed with prostate cancer.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results-Medicare-linked data to identify 98,883 men diagnosed with prostate cancer from 1996 to 2007. We stratified frequency of PSA testing as none, 1 to 2, 3 to 5, and≥6 tests in the 5 years before prostate cancer diagnosis. We used propensity scoring methods to assess the effect of frequency of PSA testing on likelihood of (1) metastases at diagnosis and (2) overall mortality and prostate cancer-specific mortality.
  
  
  RESULTS
  In adjusted analyses, the likelihood of being diagnosed with metastatic prostate cancer decreased with greater frequency of PSA testing (none, 10.6; 1-2, 8.3; 3-5, 3.7; and≥6, 2.5 events per 100 person years, P<0.001). Additionally, greater frequency of PSA testing was associated with improved overall survival and prostate cancer-specific survival (P<0.001 for both).
  
  
  CONCLUSIONS
  Greater frequency of PSA testing in men 70 years of age or older in the 5 years before prostate cancer diagnosis is associated with lower likelihood of being diagnosed with metastatic prostate cancer and improved overall and prostate cancer-specific survival.
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: jimhumd@gmail.com.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Williams
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Stacey C
authors.initials: SC
authors.lastname: Carter
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC.
authors.forename: Sandip
authors.initials: S
authors.lastname: Prasad
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Karim
authors.initials: K
authors.lastname: Chamie
authors.affiliation: Department of Urology, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l׳Université de Montréal, Montreal, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Department of Radiation Oncology, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Center for Surgery and Public Health, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006801:Humans; D007610:Kallikreins / Q000032:analysis*; D008297:Male; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Elderly; Mortality; PSA; Prostate-specific antigen; Survival