Baseline Serum Prostate-specific Antigen Value Predicts the Risk of Subsequent Prostate Cancer Death-Results from the Norwegian Prostate Cancer Consortium

Johan Bjerner; Ola Bratt; Kirsti Aas; Peter C Albertsen; Sophie D Fosså; Rune Kvåle; Hans Lilja; Christoph Müller; Stig Müller; Andreas Stensvold; Owen Thomas; Oluf D Røe; Andrew Vickers; Jochen Walz; Sigrid V Carlsson; Jan Oldenburg

doi:10.1016/j.eururo.2023.04.028

Baseline Serum Prostate-specific Antigen Value Predicts the Risk of Subsequent Prostate Cancer Death-Results from the Norwegian Prostate Cancer Consortium

Eur Urol. 2023 May 9:S0302-2838(23)02791-4. doi: 10.1016/j.eururo.2023.04.028. Online ahead of print.

Authors

Johan Bjerner¹, Ola Bratt², Kirsti Aas³, Peter C Albertsen⁴, Sophie D Fosså⁵, Rune Kvåle⁶, Hans Lilja⁷, Christoph Müller⁸, Stig Müller⁹, Andreas Stensvold¹⁰, Owen Thomas¹¹, Oluf D Røe¹², Andrew Vickers¹³, Jochen Walz¹⁴, Sigrid V Carlsson¹⁵, Jan Oldenburg¹⁶

Affiliations

¹ Fürst Laboratories, Department of Clinical Chemistry, Oslo, Norway.
² Department of Urology, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
³ Department of Urology, Oslo University Hospital, Oslo, Norway.
⁴ Division of Urology, Department of Surgery, University of Connecticut Health Center, Farmington, CT, USA.
⁵ National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, Oslo, Norway; Medical Faculty of University of Oslo, Oslo, Norway.
⁶ Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway; Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.
⁷ Departments of Laboratory Medicine, Surgery and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden.
⁸ Department of Oncology, Sørlandet Sykehus, Kristiansand, Norway.
⁹ Department of Urology, Akershus University Hospital, Lørenskog, Norway.
¹⁰ Department of Oncology, Østfold Sykehus, Kalnes, Norway.
¹¹ Department of Biostatistics, Akershus University Hospital, Lørenskog, Norway.
¹² Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Cancer Clinic, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
¹³ Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
¹⁴ Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France.
¹⁵ Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁶ Medical Faculty of University of Oslo, Oslo, Norway; Department of Oncology, Akershus University Hospital, Lørenskog, Norway. Electronic address: janold@ahus.no.

PMID: 37169639
PMCID: PMC10840440 (available on 2024-11-09)
DOI: 10.1016/j.eururo.2023.04.028

Abstract

Background: Prostate-specific antigen (PSA) levels in midlife are strongly associated with the long-term risk of lethal prostate cancer in cohorts not subject to screening. This is the first study evaluating the association between PSA levels drawn as part of routine medical care in the Norwegian population and prostate cancer incidence and mortality.

Objective: To determine the association between midlife PSA levels <4.0 ng/ml, drawn as part of routine medical care, and long-term risk of prostate cancer death.

Design, setting, and participants: The Norwegian Prostate Cancer Consortium collected >8 million PSA results from >1 million Norwegian males ≥40 yr of age. We studied 176 099 men (predefined age strata: 40-54 and 55-69 yr) without a prior prostate cancer diagnosis who had a nonelevated baseline PSA level (<4.0 ng/ml) between January 1, 1995 and December 31, 2005.

Intervention: Baseline PSA.

Outcome measurements and statistical analysis: We assessed the 16-yr risk of prostate cancer mortality. We calculated the discrimination (C-index) between predefined PSA strata (<0.5, 0.5-0.9, 1.0-1.9, 2.0-2.9, and 3.0-3.9 ng/ml) and subsequent prostate cancer death. Survival curves were plotted using the Kaplan-Meier method.

Results and limitations: The median follow-up time of men who did not get prostate cancer was 17.9 yr. Overall, 84% of men had a baseline PSA level of <2.0 ng/ml and 1346 men died from prostate cancer, with 712 deaths (53%) occurring in the 16% of men with the highest baseline PSA of 2.0-3.9 ng/ml. Baseline PSA levels were associated with prostate cancer mortality (C-index 0.72 for both age groups, 40-54 and 55-69 yr). The fact that the reason for any given PSA measurement remains unknown represents a limitation.

Conclusions: We replicated prior studies that baseline PSA at age 40-69 yr can be used to stratify a man's risk of dying from prostate cancer within the next 15-20 yr.

Patient summary: A prostate-specific antigen level obtained as part of routine medical care is strongly associated with a man's risk of dying from prostate cancer in the next two decades.

Keywords: Prostate cancer; Prostate-specific antigen; Screening.

Abstract

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