title: Determining optimal prostate-specific antigen thresholds to identify an increased 4-year risk of prostate cancer development: an analysis within the Veterans Affairs Health Care System.
abstract: OBJECTIVE
  To assess the prostate-specific antigen (PSA) threshold value that optimally predicts future risk of prostate cancer (overall and by race) for a dispersed US population.
  
  
  METHODS
  This was a retrospective analysis of men in the Veterans Affairs (VA) Health Care System database. Men ≥ 40 years with a baseline PSA ≤ 4.0 ng/mL, not receiving 5-alpha reductase inhibitors, and without a prostate cancer diagnosis prior to baseline PSA date were included and followed for 4 years. Patients diagnosed with prostate cancer within 6 months of baseline were excluded. The optimal PSA threshold value for future 4-year prostate cancer risk was determined by maximizing Youden's index.
  
  
  RESULTS
  The eligible population for the final analysis included 41,250 Caucasian (n = 24,518; 59.4 %) and African American (n = 16,732; 40.6 %) patients. The 4-year prostate cancer rate was 3.08 % overall, and race-specific rates were 3.02 and 3.17 % for Caucasian and African American men, respectively. Mean time to prostate cancer diagnosis was 2.01 years across all patients. Race-specific PSA thresholds that optimally predicted future prostate cancer were 2.5 ng/mL [area under the curve (AUC) = 80.3 %] in Caucasians and a 1.9 ng/mL (AUC = 85.4 %) in African Americans; across all patients, a 2.4 ng/mL threshold was optimal (AUC = 82.5 %).
  
  
  CONCLUSIONS
  In the VA population, a relatively low PSA threshold of ~2.5 ng/mL was optimal in predicting prostate cancer within 4 years overall and for Caucasian men, but an even lower threshold of 1.9 ng/mL was applicable for African American men.
authors.affiliation: South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, 29208-0001, USA. Sutton@sccp.sc.edu.|Dorn Research Institute, WJB Dorn Veterans Affairs Medical Center, Columbia, SC, USA. Sutton@sccp.sc.edu.
authors.forename: S Scott
authors.initials: SS
authors.lastname: Sutton
authors.affiliation: University of Colorado Health Sciences Center, Denver, CO, USA.
authors.forename: E David
authors.initials: ED
authors.lastname: Crawford
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
authors.affiliation: Dorn Research Institute, WJB Dorn Veterans Affairs Medical Center, Columbia, SC, USA.|Biostatistics Collaborative Group, University of South Carolina, Columbia, SC, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Hardin
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Kruep
mesh_terms: D001741:Black or African American; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D044465:White People
chemical_list: D017430:Prostate-Specific Antigen
keywords: African American; Caucasian; Prostate-specific antigen; Prostatic neoplasms