Superiority of Midlife Baseline Prostate-Specific Antigen Value over PSA Doubling Time and Velocity in the Prediction of Lethal Prostate Cancer Development, and Mortality: A System Wide Analysis of a Racially Diverse North American Cohort

You have accessJournal of UrologyProstate Cancer: Detection & Screening VI (MP74), Moderated Poster 741 May 2024MP74-03 SUPERIORITY OF MIDLIFE BASELINE PROSTATE-SPECIFIC ANTIGEN VALUE OVER PSA DOUBLING TIME AND VELOCITY IN THE PREDICTION OF LETHAL PROSTATE CANCER DEVELOPMENT, AND MORTALITY: A SYSTEM WIDE ANALYSIS OF A RACIALLY DIVERSE NORTH AMERICAN COHORT Matthew Davis, Giuseppe O. Cirulli, Alex Stephens, Giuseppe Chiarelli, Marco Finati, Chase Morrison, Shane Tinsley, Sohrab Arora, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Giuseppe Carrieri, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Craig Rogers, and Firas Abdollah Matthew DavisMatthew Davis , Giuseppe O. CirulliGiuseppe O. Cirulli , Alex StephensAlex Stephens , Giuseppe ChiarelliGiuseppe Chiarelli , Marco FinatiMarco Finati , Chase MorrisonChase Morrison , Shane TinsleyShane Tinsley , Sohrab AroraSohrab Arora , Akshay SoodAkshay Sood , Nicolò BuffiNicolò Buffi , Giovanni LughezzaniGiovanni Lughezzani , Giuseppe CarrieriGiuseppe Carrieri , Andrea SaloniaAndrea Salonia , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Craig RogersCraig Rogers , and Firas AbdollahFiras Abdollah View All Author Informationhttps://doi.org/10.1097/01.JU.0001008632.59099.b9.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our findings are that PSAV or PSADT were not superior to midlife baseline PSA in predicting the development of lethal PCa. This suggests that these variables may not have practical utility in enhancing PSA screening strategies in a clinical setting. METHODS: Men aged 40–59 years, who received their first PSA between the years 1995 and 2019 were included. For MB PSA values, the first PSA test result was included. For PSADT, the first two PSA test results were included. For PSAV, the first three PSA test results within 30 months were included. Selection criteria resulted in a total of 78,625 patients with at least 2 PSA test results and 13,062 patients with at least 3 PSA test results. Multivariable Fine-Gray regression was used to examine the impact of the value of the PSA testing methods on the development of lethal PCa. Time-dependent ROC/AUC curves at 5, 10, and 15 years were plotted. RESULTS: In the main cohort, patients were most frequently in the 50–54 age category (32.8%), had a CCI of 0 (70.5%), and were white (63.2%). Of these, 9.3% had the midlife baseline PSA in the top 10th percentile, and 0.4% had a PSADT 0 – 6 months. Lethal PCa was diagnosed in 636 (0.8%) patients. The median (IQR) follow-up time was 11 (5.1 – 17.4) years. In the main cohort, MB PSA and PSADT were significant predictors for lethal PCa, with a HR 5.47 (95% CI: 4.40-6.78) and HR 2.81(95% CI: 1.45-5.45) for patients in the top 10th percentile MB PSA group and in the PSADT between 0-<6 months group, respectively. In patients with 3 PSA results available, MB PSA and PSAV were significant predictors for lethal PCa, with a HR 5.05 (95% CI: 3.16-8.06) and 3.26 (95% CI: 2.09-5.07) for patients in the top 10th percentile MB PSA group and in the PSAV >0.4 ng/mL/year group, respectively. PSADT and PSAV did not have higher AUCs than MB PSA in predicting lethal PCa. Specifically, they were 0.712 and 0.639 at 10- and 15-year, respectively, for the PSADT; 0.749 and 0.708 at 10- and 15-year, respectively, for the PSAV and 0.840 and 0.750 at 10- and 15-year, respectively, for the MB PSA (all p>0.05). CONCLUSIONS: Our findings are that PSAV or PSADT were not superior to midlife baseline PSA in predicting the development of lethal PCa. This suggests that these variables may not have practical utility in enhancing PSA screening strategies in a clinical setting. Source of Funding: Vattikuti foundation and Menon foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1193 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Matthew Davis More articles by this author Giuseppe O. Cirulli More articles by this author Alex Stephens More articles by this author Giuseppe Chiarelli More articles by this author Marco Finati More articles by this author Chase Morrison More articles by this author Shane Tinsley More articles by this author Sohrab Arora More articles by this author Akshay Sood More articles by this author Nicolò Buffi More articles by this author Giovanni Lughezzani More articles by this author Giuseppe Carrieri More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...