Pd50-10 Free Psa and Risk of Gleason Grade Group ≥2 and Fatal Prostate Cancer in Black Men: Implications for Risk-Stratified Screening

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 May 2024PD50-10 FREE PSA AND RISK OF GLEASON GRADE GROUP ≥2 AND FATAL PROSTATE CANCER IN BLACK MEN: IMPLICATIONS FOR RISK-STRATIFIED SCREENING Kendrick Yim, Chris Magnani, Sigrid Carlsson, Martha Shrubsole, Kathryn Penney, Hans Lilja, Andrew Vickers, Quoc Trinh, Scott Eggener, Lorelei Mucci, and Mark A. Preston Kendrick YimKendrick Yim , Chris MagnaniChris Magnani , Sigrid CarlssonSigrid Carlsson , Martha ShrubsoleMartha Shrubsole , Kathryn PenneyKathryn Penney , Hans LiljaHans Lilja , Andrew VickersAndrew Vickers , Quoc TrinhQuoc Trinh , Scott EggenerScott Eggener , Lorelei MucciLorelei Mucci , and Mark A. PrestonMark A. Preston View All Author Informationhttps://doi.org/10.1097/01.JU.0001008620.35181.96.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Black men are at a higher risk of advanced prostate cancer and less likely to obtain definitive treatment. Percent free PSA (%fPSA) has been shown to be useful in risk stratified prostate cancer screening, but there is limited data examining %fPSA in Black men. We studied whether adding %fPSA to total PSA (tPSA) improves prediction of Gleason Grade Group≥2 (GGG≥2) prostate cancer (PCa) and fatal PCa in a population of Black men. METHODS: Nested case-control study within the Southern Community Cohort Study, a prospective cohort in southeastern US. 952 Black men aged 40-74 were selected. Controls (n=714, men without prostate cancer) were matched 3:1 to 238 prostate cancer cases on age (±1 year), health center, and blood draw year. GGG≥2 PCa was defined as GG2 or greater on pathology, AJCC Stage≥3, or fatal PCa. Among cases, 113 had GGG≥2 PCa and 19 fatal PCa. Total PSA and %fPSA were measured in baseline blood draw. Area under the curve (AUC) evaluated predictive ability of tPSA and %fPSA for PCa outcomes. Conditional logistic regression was performed to evaluate the association between age, tPSA, and %fPSA with GGG≥2 PCa and fatal PCa. RESULTS: Median follow-up was 9.2 years. Median tPSA was 0.91 ng/mL amongst controls and 3.59 ng/mL amongst cases. Median %fPSA was 30.5% for controls and 15.5% for cases. Prediction of GGG≥2 PCa increased (AUC 0.81 to 0.85) with addition of %fPSA to base model of age+tPSA. Prediction improved in younger (age 40-60, AUC 0.77 to 0.84) and older men (age 61-74, AUC 0.73 to 0.83). For fatal PCa, AUC increased in younger (0.73 to 0.89) and older men (0.85 to 0.89). Compared to men with %fPSA >30%, men with %fPSA <30% had an increased risk of GGG≥2 PCa; OR were 4.5(95% CI 1.9–10.9) for %fPSA 20-29%, 18.3(95% CI 7.9–42.3) for %fPSA 10–19% and 56.9(95% CI 22.5–149.9) for %fPSA <10% (Table 1). Men with a %fPSA 10-19%(OR 12.6, 95%CI 1.5 – 107.1) and <10%(OR 78.8, 95% CI 9.3–668.2) had increased risk of fatal PCa. CONCLUSIONS: In a large prospective cohort of Black men, the addition of %fPSA to tPSA improved prediction of GGG≥2 and fatal PCa. Additionally, %fPSA improved prediction across ages 40-74. %fPSA should be used to risk-stratify screening in all men to identify those at highest risk of developing GGG≥2 PCa and as a reflex test to decrease unnecessary prostate biopsies. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1061 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kendrick Yim More articles by this author Chris Magnani More articles by this author Sigrid Carlsson More articles by this author Martha Shrubsole More articles by this author Kathryn Penney More articles by this author Hans Lilja More articles by this author Andrew Vickers More articles by this author Quoc Trinh More articles by this author Scott Eggener More articles by this author Lorelei Mucci More articles by this author Mark A. Preston More articles by this author Expand All Advertisement PDF downloadLoading ...