Andrew J Simpkin1, Jenny L Donovan1, Kate Tilling1, J Athene Lane1, Richard M Martin1,2, Peter C Albertsen3, Anna Bill-Axelson4, H Ballentine Carter5, J L H Ruud Bosch6, Luigi Ferrucci7, Freddie C Hamdy8, Lars Holmberg9,10, E Jeffrey Metter11, David E Neal12, Christopher C Parker13, Chris Metcalfe1. 1. School of Social and Community Medicine, University of Bristol, Bristol, UK. 2. NIHR Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK. 3. Division of Urology, University of Connecticut Health Center, Farmington, CT, USA. 4. Institution of Surgical Sciences, Department of Urology, Uppsala University, Uppsala, Sweden. 5. Department of Urology, Johns Hopkins School of Medicine, Baltimore, MA, USA. 6. Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands. 7. National Institute on Aging, National Institutes of Health, Baltimore, MA, USA. 8. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. 9. Faculty of Life Sciences and Medicine, King's College London, London, UK. 10. Regional Cancer Centre, Uppsala/Örebro Region, Uppsala, Sweden. 11. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA. 12. Department of Oncology, University of Cambridge, Cambridge, UK. 13. Academic Urology Unit, Royal Marsden Hospital, Institute of Cancer Research, London, UK.
Abstract
OBJECTIVE: To determine whether there are differences in prostate-specific antigen (PSA) levels at diagnosis or changes in PSA levels between US and European populations of men with and without prostate cancer (PCa). SUBJECTS AND METHODS: We analysed repeated measures of PSA from six clinically and geographically diverse cohorts of men: two cohorts with PSA-detected PCa, two cohorts with clinically detected PCa and two cohorts without PCa. Using multilevel models, average PSA at diagnosis and PSA change over time were compared among study populations. RESULTS: The annual percentage PSA change of 4-5% was similar between men without cancer and men with PSA-detected cancer. PSA at diagnosis was 1.7 ng/mL lower in a US cohort of men with PSA-detected PCa (95% confidence interval 1.3-2.0 ng/mL), compared with a UK cohort of men with PSA-detected PCa, but there was no evidence of a different rate of PSA change between these populations. CONCLUSION: We found that PSA changes over time are similar in UK and US men diagnosed through PSA testing and even in men without PCa. Further development of PSA models to monitor men on active surveillance should be undertaken in order to take advantage of these similarities. We found no evidence that guidelines for using PSA to monitor men cannot be passed between US and European studies.
OBJECTIVE: To determine whether there are differences in prostate-specific antigen (PSA) levels at diagnosis or changes in PSA levels between US and European populations of men with and without prostate cancer (PCa). SUBJECTS AND METHODS: We analysed repeated measures of PSA from six clinically and geographically diverse cohorts of men: two cohorts with PSA-detected PCa, two cohorts with clinically detected PCa and two cohorts without PCa. Using multilevel models, average PSA at diagnosis and PSA change over time were compared among study populations. RESULTS: The annual percentage PSA change of 4-5% was similar between men without cancer and men with PSA-detected cancer. PSA at diagnosis was 1.7 ng/mL lower in a US cohort of men with PSA-detected PCa (95% confidence interval 1.3-2.0 ng/mL), compared with a UK cohort of men with PSA-detected PCa, but there was no evidence of a different rate of PSA change between these populations. CONCLUSION: We found that PSA changes over time are similar in UK and US men diagnosed through PSA testing and even in men without PCa. Further development of PSA models to monitor men on active surveillance should be undertaken in order to take advantage of these similarities. We found no evidence that guidelines for using PSA to monitor men cannot be passed between US and European studies.
Authors: Freddie C Hamdy; Jenny L Donovan; J Athene Lane; Malcolm Mason; Chris Metcalfe; Peter Holding; Julia Wade; Sian Noble; Kirsty Garfield; Grace Young; Michael Davis; Tim J Peters; Emma L Turner; Richard M Martin; Jon Oxley; Mary Robinson; John Staffurth; Eleanor Walsh; Jane Blazeby; Richard Bryant; Prasad Bollina; James Catto; Andrew Doble; Alan Doherty; David Gillatt; Vincent Gnanapragasam; Owen Hughes; Roger Kockelbergh; Howard Kynaston; Alan Paul; Edgar Paez; Philip Powell; Stephen Prescott; Derek Rosario; Edward Rowe; David Neal Journal: Health Technol Assess Date: 2020-08 Impact factor: 4.014