Pd19-01 Variation of Serum Prostate Specific Antigen (Psa) Levels in the Plco Cohort: Are Guideline Recommendations to Repeat an Elevated Screening Psa Justified?

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (PD19)1 May 2024PD19-01 VARIATION OF SERUM PROSTATE SPECIFIC ANTIGEN (PSA) LEVELS IN THE PLCO COHORT: ARE GUIDELINE RECOMMENDATIONS TO REPEAT AN ELEVATED SCREENING PSA JUSTIFIED? Maria M. Pere, Emily A. Vertosick, Andrew J. Vickers, Hans Lilja, James A. Eastham, and Sigrid V. Carlsson Maria M. PereMaria M. Pere , Emily A. VertosickEmily A. Vertosick , Andrew J. VickersAndrew J. Vickers , Hans LiljaHans Lilja , James A. EasthamJames A. Eastham , and Sigrid V. CarlssonSigrid V. Carlsson View All Author Informationhttps://doi.org/10.1097/01.JU.0001009448.41537.64.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Repeating an elevated Prostate Specific Antigen (PSA) is a guideline-recommended part of the pre-biopsy work-up lacking a strong evidence base. Intra-individual PSA variability has received little attention apart from a single study (Eastham JAMA 2003) that has not been replicated in a larger cohort. We use the Prostate Lung Colorectal Ovarian (PLCO) cancer screening trial to determine yearly PSA variation and consequences for repeating an elevated PSA. METHODS: Retrospective analysis of men participating in the PLCO trial who received PSA testing at yearly intervals for 6 years and were not diagnosed with prostate cancer. The outcome was defined as having a PSA above the threshold of interest and having the subsequent year's measurement below the threshold of interest (varied in sensitivity analyses to be 2.5 ng/mL, 3 ng/mL and 4 ng/mL). Analyses were conducted both at the level of the PSA measurement (what is the probability that an elevated PSA measure will drop below the threshold?) and of the patient (what is the probability that a patient will have at least one elevated PSA drop below the threshold during the course of the study?). RESULTS: There were 11,176 men in the PLCO cohort with PSA testing at yearly intervals for 6 years and a median baseline age of 60 years (IQR 57,65). 2,700, 1,928, and 952 patients were eligible for the analysis threshold of 2.5 ng/mL, 3 ng/mL and 4 ng/mL, respectively. Among all PSAs≥2.5 ng/mL, 22% (95% CI 21%, 23%) dropped below 2.5 ng/mL the following year; rates were similar for 3 and 4 ng/mL (Table 1). Among men with at least one PSA≥2.5 ng/mL in the study, 54% (95% CI 53%, 56%) had a level dropping below this threshold by the following year. Again, results were similar for higher thresholds. When excluding men with an initial PSA-level in the trial above the threshold, the proportions of PSAs decreasing below the threshold the following year were larger: around 40% at the PSA level and 65% at the patient level. CONCLUSIONS: In a large screening trial, we show that PSA levels measured at yearly intervals fluctuate which is why an isolated PSA elevation should be repeated. This supports guidelines that abnormal PSA results should be confirmed to minimize patient worry, unnecessary biopsy and risk of overdiagnosis of low-grade cancer. Source of Funding: NIH/NCI (P30-CA008748) (U01-CA266535) © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e439 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Maria M. Pere More articles by this author Emily A. Vertosick More articles by this author Andrew J. Vickers More articles by this author Hans Lilja More articles by this author James A. Eastham More articles by this author Sigrid V. Carlsson More articles by this author Expand All Advertisement PDF downloadLoading ...