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Prostate cancer risk assessment in men with an initial P.S.A. below 3 ng/mL: results from the Göteborg randomized population-based prostate cancer screening trial.

Artikel i vetenskaplig tidskrift
Författare Maria Frånlund
Rebecka Arnsrud Godtman
Sigrid Carlsson
Hans Lilja
Marianne Månsson
Johan Stranne
Jonas Hugosson
Publicerad i Scandinavian journal of urology
Volym 52
Nummer/häfte 4
Sidor 1-7
ISSN 2168-1813
Publiceringsår 2018
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för urologi
Sidor 1-7
Språk en
Länkar dx.doi.org/10.1080/21681805.2018.15...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Urologi och andrologi, Cancer och onkologi

Sammanfattning

To evaluate the long-term outcome of men with an initial prostate-specific antigen (PSA) level below 3 ng/mL and whether the free-to-total (F/T PSA) ratio is a useful prognostic marker in this range.This study is based on 5,174 men aged 50-66 years, who in 1995-1996 participated in the first round of the Göteborg randomized screening trial (initial T-PSA level <3 ng/mL). These men were subsequently invited biennially for PSA and F/T PSA screening until they reached the upper age limit (on average 69 years). Biopsy was recommended if PSA ≥ 3 ng/mL.After a median follow-up of 18.9 years, 754 men (14.6%) were diagnosed with prostate cancer (PC). The overall cumulative PC incidence was 17.2%. It increased from 7.9% among men with T-PSA of ≤0.99 ng/mL to 26.0% in men with T-PSA levels of 1-1.99 ng/mL and 40.3% in men between 2-2.99 ng/mL (p < 0.001). The initial PSA was also related to the incidence of Gleason ≥7 PC (3.7% vs 9.7% vs 10.9%) and PC death (0.3% vs 1.1% vs 1.5%). Adding F/T PSA did not improve PC prediction in terms of Harrell concordance index (base model 0.76 vs 0.76) nor improvement of the likelihood of the model (p = 0.371).Some men with initial PSA < 3 ng/mL will be diagnosed too late, despite participating in an organized screening program, indicating that prompt diagnosis is justified in these men. PC incidence and risk of PC death was associated with PSA., but F/T PSA had no predictive value.

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