Age and PSA predict likelihood of organ-confined disease in men presenting with PSA less than 10 ng/mL: implications for screening.


OBJECTIVES To examine age and pretreatment prostate-specific antigen (PSA) level as predictors of organ-confined disease in a large multinational database of men with pretreatment PSA levels less than 10 ng/mL who were treated with radical prostatectomy. The optimal PSA and age cutoffs for triggering prostate biopsy are controversial. Although a PSA level greater than 4.0 ng/mL is generally accepted, recent observations suggest that PSA values between 2.5 and 4.0 ng/mL are associated with a 20% detection rate. Furthermore, age has been shown to represent an independent predictor of outcome after radical prostatectomy. METHODS We analyzed a cohort of 3198 patients from five institutions, who underwent radical prostatectomy between 1985 and 2001 for clinically localized prostate cancer. All presented with a pretreatment PSA level of less than 10 ng/mL. Multivariate analyses addressed age, preoperative PSA, year of treatment, biopsy Gleason sum, and clinical stage as independent predictors of non-organ-confined disease (NOCD). RESULTS Twenty-nine percent of patients had NOCD. All tested variables were independent, multivariate predictors of NOCD (age, P = 0.004; year of treatment, P <0.0001; PSA, P <0.0001; Gleason sum, P <0.0001; clinical stage, P <0.0001). A linear relationship between age and the risk of NOCD was noted. The likelihood of NOCD remained constant for PSA levels between 0.1 and 4.0 ng/mL and rose substantially for PSA levels greater than 4.0 ng/mL. CONCLUSIONS After controlling for other covariates, the rate of NOCD increased in proportion to age and pretreatment PSA level in men initially diagnosed with a serum PSA level less than 10 ng/mL. These observations suggest that younger men with a lower PSA are more likely to have organ-confined and curable disease at diagnosis. This information has important implications for counseling and screening.

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@article{Aleman2003AgeAP, title={Age and PSA predict likelihood of organ-confined disease in men presenting with PSA less than 10 ng/mL: implications for screening.}, author={Michael A Aleman and Pierre I. Karakiewicz and Patrick Kupelian and Michael W. Kattan and Markus Graefen and Ilias Cagiannos and James Eastham and Peter T. Scardino and Hartwig Huland and Eric Klein}, journal={Urology}, year={2003}, volume={62 1}, pages={70-4} }