S Scott Sutton1,2, E David Crawford3, Judd W Moul4, James W Hardin5,6, Eric Kruep7. 1. South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, 29208-0001, USA. Sutton@sccp.sc.edu. 2. Dorn Research Institute, WJB Dorn Veterans Affairs Medical Center, Columbia, SC, USA. Sutton@sccp.sc.edu. 3. University of Colorado Health Sciences Center, Denver, CO, USA. 4. Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA. 5. Dorn Research Institute, WJB Dorn Veterans Affairs Medical Center, Columbia, SC, USA. 6. Biostatistics Collaborative Group, University of South Carolina, Columbia, SC, USA. 7. Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Abstract
PURPOSE: 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.
PURPOSE: 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.
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