Probability of an Abnormal Screening Prostate-specific Antigen Result Based on Age, Race, and Prostate-specific Antigen Threshold - 27/02/14

Doi : 10.1016/j.urology.2013.10.051

Roxanne Espaldon ^a, Katharine A. Kirby ^a, Kathy Z. Fung ^a, Richard M. Hoffman ^b, Adam A. Powell ^c,^d, Stephen J. Freedland ^e,^f, Louise C. Walter ^a,^⁎
^a Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA
^b Department of Medicine, University of New Mexico, New Mexico VA Health Care System, Albuquerque, NM
^c Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
^d Department of Medicine, University of Minnesota, Minneapolis, MN
^e Durham VA Medical Center, Durham, NC
^f Duke Prostate Center, Duke University, Durham, NC

^∗Reprint requests: Louise C. Walter, M.D., Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center 181G, 4150 Clement Street, San Francisco, CA 94121.

Abstract

Objective

To determine the distribution of screening prostate-specific antigen (PSA) values in older men, and how different PSA thresholds affect the proportion of white, black, and Latino men who would have an abnormal screening result across advancing age groups.

Methods

We used linked national Veterans Affairs and Medicare data to determine the value of the first screening PSA test (ng/mL) of 327,284 men older than 65 years who underwent PSA screening in the Veterans Affairs health care system in 2003. We calculated the proportion of men with an abnormal PSA result based on age, race, and common PSA thresholds.

Results

Among men older than 65 years, 8.4% had a PSA >4.0 ng/mL. The percentage of men with a PSA >4.0 ng/mL increased with age and was highest in black men (13.8%) vs white (8.0%) or Latino men (10.0%) (P <.001). Combining age and race, the probability of having a PSA >4.0 ng/mL ranged from 5.1% of Latino men aged 65-69 years to 27.4% of black men older than 85 years. Raising the PSA threshold from >4.0 ng/mL to >10.0 ng/mL reclassified the greatest percentage of black men older than 85 years (18.3% absolute change) and the lowest percentage of Latino men aged 65-69 years (4.8% absolute change) as being under the biopsy threshold (P <.001).

Conclusion

Age, race, and PSA threshold together affect the pretest probability of an abnormal screening PSA result. Based on screening PSA distributions, stopping screening among men whose PSA <3 ng/mL means more than 80% of white and Latino men older than 70 years would stop further screening, and increasing the biopsy threshold to >10 ng/mL has the greatest effect on reducing the number of older black men who will face biopsy decisions after screening.

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Plan

Methods

Data Sources and Patients

Participant Characteristics

Screening PSA Results

Comment

Conclusion

Financial Disclosure: The authors declare that they have no relevant financial interests.

Funding Support: This work was supported by the National Cancer Institute at the National Institutes of Health (grant number R01 CA134425 to L.W., S.F., A.P., and R.H.); the National Institute on Aging at the National Institutes of Health (grant number K24AG041180 to L.W.); the Veterans Affairs Career Development Award Program (grant number CDA 08-024 to A.P.); and the New Mexico VA Health Care System to R.H.