Association of PSA variability with prostate cancer development using large-scale medical information data: a retrospective cohort study

Ayako Maeda-Minami; Tomoki Nishikawa; Hideki Ishikawa; Michihiro Mutoh; Kazunori Akimoto; Yutaka Matsuyama; Yasunari Mano; Hiroji Uemura

doi:10.1186/s41021-023-00280-7

Association of PSA variability with prostate cancer development using large-scale medical information data: a retrospective cohort study

Genes Environ. 2023 Oct 17;45(1):25. doi: 10.1186/s41021-023-00280-7.

Authors

Ayako Maeda-Minami¹, Tomoki Nishikawa¹, Hideki Ishikawa², Michihiro Mutoh², Kazunori Akimoto¹, Yutaka Matsuyama³, Yasunari Mano⁴, Hiroji Uemura⁵

Affiliations

¹ Faculty of Pharmaceutical Sciences, Tokyo University of Science, Yamazaki, Noda, 2641, 278-8510, Chiba, Japan.
² Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
³ Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan.
⁴ Faculty of Pharmaceutical Sciences, Tokyo University of Science, Yamazaki, Noda, 2641, 278-8510, Chiba, Japan. mano@rs.tus.ac.jp.
⁵ Yokohama City University Medical Center, Yokohama, Japan.

Abstract

Background: Prostate cancer is one of the most common cancers among men worldwide and the fourth most common cause of death. The number of prostate cancer cases and deaths is increasing every year because of population aging. This study aimed to clarify the risk of developing prostate cancer due to fluctuations in Prostate Specific Antigen (PSA) levels in patients without a history of prostate cancer using large medical information data.

Results: This retrospective cohort included 1707 male patients aged 60 years or older who had a PSA level measurement date (2-PSA) within 3 months or more and 2 years from the first PSA level measurement date (1-PSA) in the database between 2008 and 2019. We subtracted 1-PSA from 2-PSA and designated patients with a higher 2-PSA than 1-PSA to the "up" group (n = 967) and patients with a lower 2-PSA than 1-PSA to the "down" group (n = 740). By using Cox proportional hazards model, a significant increase in prostate cancer risk was observed in the up group compared with the down group (adjusted hazard ratio [HR] = 1.82, 95% confidence interval [CI] = 1.21-2.72; adjusted for patient background factors). Subgroup analysis showed that patients with PSA levels < 4 ng/mL had a significantly increased risk of developing prostate cancer if the next PSA level increases by approximately 20% (adjusted HR = 2.94, 95% CI = 1.14-7.58), and patients with PSA levels of 4 ng/mL or higher if the next PSA level is decreased by approximately 20% had a significantly reduced risk of developing prostate cancer (adjusted HR = 0.36, 95% CI = 0.18-0.74), compared to that with no change.

Conclusions: This is the first study to clarify the association between PSA variability and risk of developing prostate cancer in patients without a history of prostate cancer. These results suggest that the suppression of elevated PSA levels may lead to the prevention of prostate cancer and that it would be better to perform a biopsy because the risk of developing prostate cancer may increase in the future if the PSA value increases above a certain level.

Keywords: Claim database; Prostate cancer; Prostate specific Antigen; Real-word data; Retrospective cohort study.

Abstract

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