title: Baseline PSA in a Spanish male population aged 40-49 years anticipates detection of prostate cancer.
abstract: BACKGROUND
  We researched the usefulness of optimizing prostate cancer (PC) screening in our community using baseline PSA readings in men between 40-49 years of age.
  
  
  METHODS
  A retrospective study was performed that analyzed baseline PSA in the fifth decade of life and its ability to predict the development of PC in a population of Madrid (Spain). An ROC curve was created and a cutoff was proposed. We compared the evolution of PSA from baseline in patients with consecutive readings using the Friedman test. We established baseline PSA ranges with different risks of developing cancer and assessed the diagnostic utility of the annual PSA velocity (PSAV) in this population.
  
  
  RESULTS
  Some 4,304 men aged 40-49 years underwent opportunistic screening over the course of 17 years, with at least one serum PSA reading (6,001 readings) and a mean follow-up of 57.1±36.8 months. Of these, 768 underwent biopsy of some organ, and 104 underwent prostate biopsy. Fourteen patients (.33%) were diagnosed with prostate cancer. The median baseline PSA was .74 (.01-58.5) ng/mL for patients without PC and 4.21 (.76-47.4) ng/mL for those with PC. The median time from the reading to diagnosis was 26.8 (1.5-143.8) months. The optimal cutoff for detecting PC was 1.9ng/mL (sensitivity, 92.86%; specificity, 92.54%; PPV, 3.9%; NPV, 99.97%), and the area under the curve was 92.8%. In terms of the repeated reading, the evolution of the PSA showed no statistically significant differences between the patients without cancer (p=.56) and those with cancer (P=.64). However, a PSAV value >.3ng/mL/year revealed high specificity for detecting cancer in this population.
  
  
  CONCLUSIONS
  A baseline PSA level ≥1.9ng/mL in Spanish men aged 40-49 years predicted the development of PC. This value could therefore be of use for opportunistic screening at an early age. An appropriate follow-up adapted to the risk of this population needs to be defined, but an annual PSAV ≥.3ng/mL/year appears of use for reaching an early diagnosis.
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, España; Universidad Europea de Madrid, Laureate Universities, Madrid, España. Electronic address: jangulo@futurnet.es.
authors.forename: J C
authors.initials: JC
authors.lastname: Angulo
authors.affiliation: Universidad Europea de Madrid, Laureate Universities, Madrid, España.
authors.forename: M A
authors.initials: MA
authors.lastname: Viñas
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, España.
authors.forename: H
authors.initials: H
authors.lastname: Gimbernat
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, España.
authors.forename: F Ramón de
authors.initials: FR
authors.lastname: Fata
authors.affiliation: Universidad Europea de Madrid, Laureate Universities, Madrid, España; Servicio de Anatomía Patológica, Hospital Universitario de Getafe, Getafe, Madrid, España.
authors.forename: R
authors.initials: R
authors.lastname: Granados
authors.affiliation: Servicio de Urología, Hospital Infanta Cristina, Parla, Madrid, España; Universidad Complutense de Madrid, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: Luján
mesh_terms: D000328:Adult; D000367:Age Factors; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis*; D012189:Retrospective Studies; D013030:Spain
chemical_list: D017430:Prostate-Specific Antigen
keywords: Baseline PSA; Biopsia; Biopsy; Cribado; Cáncer de próstata; PSA basal; PSA velocity; Prostate cancer; Screening; Velocidad de PSA