Age-Specific Reference Ranges for Prostate-Specific Antigen as a Marker for Prostate Cancer

Luboldt, Hans-Joachim; Schindler, Joachim F.; Rübben, H.

doi:10.1016/j.eeus.2006.10.003

Cited by 26 publications

(25 citation statements)

References 52 publications

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“…In that light, the use of age-specific PSA reference ranges has been widely welcome (18–22). However, some have argued that the use of age-specific PSA ranges runs the risk of missing clinically significant cancers in older men and augmenting the rate of unnecessary invasive procedures (and potential complications) in younger men (23). In frailty screening, similar risks could apply.…”

Section: Discussionmentioning

confidence: 99%

An alternative method for Frailty Index cut-off points to define frailty categories

Romero-Ortuño

2013

European Geriatric Medicine

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Purpose the Frailty Index (FI) is a popular operationalization of frailty. FI cut-off points have been proposed to define, regardless of age, frailty categories with increasing risk. Here, an alternative method is described that takes age into account. Subjects and methods 29,905 participants aged ≥ 50 from the first wave of the Survey of Health, Ageing and Retirement in Europe. The mean follow-up for mortality was 2.4 years. Curve estimation procedures were carried out between age and a FI, and 50% Confidence Intervals (CI) for the regression mean were derived. As opposed to the usual method (FI ≤ 0.08: non-frail; FI ≥ 0.25: frail; rest: pre-frail), the alternative method defines as ‘fit for their age’ those with a FI below the lower 50% CI; ‘frail for their age’ those with a FI above the upper 50% CI; the rest as ‘average for their age’. Using both methods, the prevalence of the frailty categories and their associated mortality rates were compared for each age group. Results The best fit between age the FI was by cubic regression (R2 = 0.174, P < 0.001). Among those in their 50s, 5% were frail by the usual method (mortality: 5%) and 14% by the alternative (mortality: 2%). Among those in their 90s, 64% were frail by the usual method (mortality: 43%) and 41% by the alternative (mortality: 48%). Conclusion the alternative method may be more sensitive in younger ages and more specific in older ages. This may have implications for population screening.

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Section: Discussionmentioning

confidence: 99%

An alternative method for Frailty Index cut-off points to define frailty categories

Romero-Ortuño

2013

European Geriatric Medicine

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“…Any PSA values stated that did not specify day or month were excluded from this study. Abnormal PSA readings were defined using outlined age‐specific PSA reference ranges adopted throughout clinical practice in Australia . Although the new PCFA/CCA guideline recommends a blanket definition of 3.0 ng/mL, age‐specific abnormal values were chosen because our data collection was initiated prior to guideline release.…”

Section: Methodsmentioning

confidence: 99%

“…Abnormal PSA readings were defined using outlined age-specific PSA reference ranges adopted throughout clinical practice in Australia. 11 Although the new PCFA/CCA guideline recommends a blanket definition of 3.0 ng/mL, age-specific abnormal values were chosen because our data collection was initiated prior to guideline release. The number of abnormal PSA readings obtained by the primary healthcare practitioner was recorded.…”

Section: Methodsmentioning

confidence: 99%

Delays in prostate cancer care within a hospital network in Victoria, Australia

Nzenza

McMillan

et al. 2019

ANZ Journal of Surgery

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Background To characterize and identify interval delays for patients referred to a tertiary hospital with prostate‐specific antigen (PSA) elevation, as delays in prostate cancer diagnosis may result in worse outcomes. Patients and methods We retrospectively reviewed consecutive referrals to our urology unit for abnormal PSA assessments, over a 24‐month period. Demographics, PSA measurements, clinical staging, biopsy grade and treatment were recorded. Referral, review, biopsy and treatment intervals were calculated. Associations were analysed using Wilcoxon rank‐sum tests. Results Two hundred and thirty men were included, with median age 65 years and PSA 7.6 ng/mL at referral, of whom 197 (85.7%) men had cancer on biopsy. The median referral, review, biopsy and treatment intervals were 8.1 (range 0.1–109.9), 1.7 (0.1–19.4), 1.9 (0.0–31.5) and 1.9 (0.2–17.3) months respectively. One hundred and seven patients (56.6%) had more than one abnormal PSA prior to referral. Eighty‐five (60.7%) patients had referral delay ≥3 months, and were found to be: older (66 versus 63 years, P = 0.02), less likely to have family history (12 versus 24%, P = 0.07) and have a prior abnormal PSA (93 versus 0%, P < 0.0001). Treatment intervals ≥1 month occurred in 104 (70.3%) patients, associated with higher clinical stage (P = 0.0002) and biopsy grade (P < 0.0001). Conclusion Our results indicate frequent referral delays, which in some cases may be reflective of older age or a lower risk profile. However, treatment delays are associated with higher risk disease, possibly reflecting time needed for staging and treatment discussions. Further efforts are needed to optimize timely referral, investigation and treatment of men with elevated PSA.

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“…In some clinical units, age-specific cutoff levels are applied, but whether this routine is of relevance is debated (42). This has encouraged searches for genetic variants that can be used to adjust or enhance the PSA test and thereby personalizing the result.…”

Section: Discussionmentioning

confidence: 99%

Androgen Receptor Polymorphism-Dependent Variation in Prostate-Specific Antigen Concentrations of European Men

Holgersson

Giwercman

Bjartell

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Androgens acting via the androgen receptor (AR) stimulate production of PSA, which is a clinical marker of prostate cancer. Because genetic variants in the AR may have a significant impact on the risk of being diagnosed with prostate cancer, the aim was to investigate whether AR variants were associated with the risk of having PSA above clinically used cutoff thresholds of 3 or 4 ng/mL in men without prostate cancer.Methods: Men without prostate cancer history (n ¼ 1,744) were selected from the European Male Ageing Study cohort of 40 to 79-year-old men from eight different European centers. Using linear and logistic regression models, with age and center as covariates, we investigated whether AR variants (CAG repeatlength and/or SNP genotype) were associated with having serum PSA concentrations above 3 or 4 ng/mL, which often are set as cutoff concentrations for further investigation of prostate cancer.Results: Carriers of the SNP rs1204038 A-allele (16% of the men) were more likely to have PSA>3 and 4 ng/mL (OR; 95% confidence intervals, 1.65; 1.13-2.40 and 1.87; 1.18-2.96, respectively) than G-allele carriers. They also had shorter CAG repeats (median 20 vs. 23, P < 0.0005), but CAG repeat length per se did not affect the PSA concentrations.Conclusion: The A-allele of the SNP rs1204038 gives a 65% higher risk of having PSA above 3 ng/mL than the G-allele in men without prostate cancer, and thereby an increased risk of being referred for further examination on suspicion of prostate cancer.Impact: Serum PSA as a clinical marker could be improved by adjustment for AR-genotype. Cancer Epidemiol Biomarkers Prev; 23(10); 2048-56. Ó2014 AACR.

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Age-Specific Reference Ranges for Prostate-Specific Antigen as a Marker for Prostate Cancer

Cited by 26 publications

References 52 publications

An alternative method for Frailty Index cut-off points to define frailty categories

An alternative method for Frailty Index cut-off points to define frailty categories

Delays in prostate cancer care within a hospital network in Victoria, Australia

Androgen Receptor Polymorphism-Dependent Variation in Prostate-Specific Antigen Concentrations of European Men

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