Emily A Vertosick1, Christel Häggström2,3, Daniel D Sjoberg1, Göran Hallmans4, Robert Johansson2, Andrew J Vickers1, Pär Stattin3, Hans Lilja5,6,7,8. 1. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York. 2. Department of Biobank Research, Umeå University, Umeå, Sweden. 3. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 4. Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden. 5. Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, New York. 6. Departments of Laboratory Medicine and Medicine (GU-Oncology Service), Memorial Sloan Kettering Cancer Center, New York, New York. 7. Department of Translational Medicine, Lund University, Malmö, Sweden. 8. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
Abstract
PURPOSE: A prespecified statistical model based on 4 kallikrein markers in blood, commercially available as the 4Kscore®, has been shown to accurately detect high grade (greater than Grade Group 2) prostate cancer in men with moderately elevated prostate specific antigen. We assessed whether the model predicted prostate cancer metastasis or death in men not subject to prostate specific antigen screening. MATERIALS AND METHODS: The cohort includes 43,692 unscreened prostate cancer-free men from a Swedish population based cohort with low rates of prostate specific antigen screening (Västerbotten Intervention Project). Using cryopreserved blood collected at ages 50 and 60 years from men in this cohort we analyzed the association between prostate specific antigen and other kallikrein marker levels in blood and risk of prostate cancer metastasis or death. RESULTS: There were 308 with metastases and 172 prostate cancer deaths. Baseline prostate specific antigen was strongly associated with 20-year risk of prostate cancer death (c-index at age 50, 0.859, 95% CI 0.799-0.916; age 60, 0.840, 95% CI 0.799-0.878). Men 60 years old with prostate specific antigen below median (less than 1.2 ng/ml) had 0.4% risk of prostate cancer death at 20 years. Among men with moderately elevated prostate specific antigen (2.0 ng/ml or greater) the 4Kscore markedly improved discrimination (c-index 0.767 vs 0.828 and 0.774 vs 0.862 in men age 50 and 60, respectively). Long-term risk of prostate cancer death or metastasis in men with low 4Kscores was very low. CONCLUSIONS: Screening should focus on men in top prostate specific antigen quartile at age 60 years. Men with elevated prostate specific antigen but a low 4Kscore can safely be monitored with repeated blood markers in place of immediate biopsy.
PURPOSE: A prespecified statistical model based on 4 kallikrein markers in blood, commercially available as the 4Kscore®, has been shown to accurately detect high grade (greater than Grade Group 2) prostate cancer in men with moderately elevated prostate specific antigen. We assessed whether the model predicted prostate cancer metastasis or death in men not subject to prostate specific antigen screening. MATERIALS AND METHODS: The cohort includes 43,692 unscreened prostate cancer-free men from a Swedish population based cohort with low rates of prostate specific antigen screening (Västerbotten Intervention Project). Using cryopreserved blood collected at ages 50 and 60 years from men in this cohort we analyzed the association between prostate specific antigen and other kallikrein marker levels in blood and risk of prostate cancer metastasis or death. RESULTS: There were 308 with metastases and 172 prostate cancer deaths. Baseline prostate specific antigen was strongly associated with 20-year risk of prostate cancer death (c-index at age 50, 0.859, 95% CI 0.799-0.916; age 60, 0.840, 95% CI 0.799-0.878). Men 60 years old with prostate specific antigen below median (less than 1.2 ng/ml) had 0.4% risk of prostate cancer death at 20 years. Among men with moderately elevated prostate specific antigen (2.0 ng/ml or greater) the 4Kscore markedly improved discrimination (c-index 0.767 vs 0.828 and 0.774 vs 0.862 in men age 50 and 60, respectively). Long-term risk of prostate cancer death or metastasis in men with low 4Kscores was very low. CONCLUSIONS: Screening should focus on men in top prostate specific antigen quartile at age 60 years. Men with elevated prostate specific antigen but a low 4Kscore can safely be monitored with repeated blood markers in place of immediate biopsy.
Entities:
Keywords:
early detection of cancer; prostate-specific antigen; prostatic neoplasms
Authors: Emily A Vertosick; Stephen Zappala; Sanoj Punnen; Jonas Hugosson; Stephen A Boorjian; Alexander Haese; Peter Carroll; Matthew Cooperberg; Anders Bjartell; Hans Lilja; Andrew J Vickers Journal: Urology Date: 2021-08-24 Impact factor: 2.649
Authors: Antti Rannikko; Mare Leht; Tuomas Mirtti; Anu Kenttämies; Teemu Tolonen; Irina Rinta-Kiikka; Tuomas P Kilpeläinen; Kari Natunen; Hans Lilja; Terho Lehtimäki; Jani Raitanen; Paula Kujala; Johanna Ronkainen; Mika Matikainen; Anssi Petas; Kimmo Taari; Teuvo Tammela; Anssi Auvinen Journal: BJU Int Date: 2022-01-08 Impact factor: 5.969