Screening Prostate-specific Antigen Concentration and Prostate Cancer Mortality: The Korean Heart Study.
OBJECTIVE
To evaluate the association between serum prostate-specific antigen (PSA) concentration from a screening test and prostate cancer mortality in an Asian population.


METHODS
We included 118,665 men in the Korean Heart Study, a large prospective cohort study of participants who voluntarily underwent private health examinations that included PSA-based prostate cancer screening. The baseline visit occurred between January 1994 and December 2004, and follow-up was through December 2011. Deaths from prostate cancer were ascertained from the underlying cause of death from a computerized search of death certificate data from the National Statistical Office in Korea. We used the Cox proportional hazards regression to estimate the association between serum PSA and risk of prostate cancer death adjusting the baseline age, cigarette smoking status, and body mass index.


RESULTS
During 1,381,901 person-years of follow-up, 6036 men died of any cause, and of these, 56 men died of prostate cancer. The multivariate-adjusted hazard ratio for prostate cancer death statistically significantly increased across PSA concentrations (P trend <.0001). The hazard ratio increased 7% per 1-ng/mL increase in PSA. The association between PSA concentration and death from prostate cancer was stronger in younger than in older men and in heavier than leaner men.


CONCLUSIONS
In conclusion, an increased screening PSA level is associated with an increased risk of prostate cancer death in Korean men. Our findings may have implications for the development of targeted PSA cutpoints for biopsy recommendation.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology and Health Promotion and Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea.
Yejin
Y
Mok
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Heejin
H
Kimm
Korea Medical Institute, Seoul, Korea.
Sang Yop
SY
Shin
Department of Epidemiology and Health Promotion and Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea. Electronic address: jsunha@yuhs.ac.
Sun Ha
SH
Jee
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD.
Elizabeth A
EA
Platz
D000328:Adult; D000368:Aged; D044466:Asian People; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality*; D056910:Republic of Korea; D012306:Risk; D055815:Young Adult
D017430:Prostate-Specific Antigen