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Publication - Dr Becky Gilbert

    Developing new age-specific prostate-specific antigen thresholds for testing for prostate cancer


    Gilbert, B, Tilling, K, Martin, R, Lane, JA, Davis, M, Hamdy, F, Neal, DE, Donovan, J & Metcalfe, C, 2018, ‘Developing new age-specific prostate-specific antigen thresholds for testing for prostate cancer’. Cancer Causes and Control.


    Purpose: To examine whether age-related reference ranges for “normal” prostate-specific antigen (PSA) change (determined in men without prostate cancer) can be used to identify men at high risk of having prostate cancer.
    Methods: Subjects were men aged 50–69 years with PSA < 10 ng/mL from the UK-based Prostate Testing for cancer and
    Treatment (ProtecT) study. Men with prostate cancer were categorized as high or low risk of progression (Low risk: Gleason
    score ≤ 6 and stage T1–T2a; High risk: Gleason score 7–10 or stage T2C). Men without prostate cancer were those with no
    histological confirmation of prostate cancer. Previously developed longitudinal reference ranges for normal age-related PSA
    change were used to calculate an age-specific PSA threshold. We compared the ability of our age-specific PSA threshold to
    discriminate between high- and no/low-risk prostate cancer with that of two existing thresholds: (i) threshold of PSA = 3 ng/
    ml for all ages; (ii) National Institute of Clinical Excellence (NICE) guidelines dependent on age-group thresholds (age
    50–59: PSA = 3 ng/mL; age 60–70: PSA = 4 ng/mL; age ≥ 70: PSA = 5 ng/mL).
    Results: We included 823 men with high-risk prostate cancer and 80,721 men with no/low-risk prostate cancer. A threshold
    of PSA = 3 ng/ml for all ages identified more high-risk prostate cancers, recommending biopsy in 9.8% of men, of which
    10.3% (n = 823) had high-risk prostate cancer. Using the NICE guidelines as the threshold for biopsy, 6.9% men were recommended
    for biopsy, of which 11.9% (n = 668) had high-risk prostate cancer. Using the new age-specific threshold for biopsy,
    2.3% men were recommended for biopsy, of which 15.2% (n = 290) had high-risk prostate cancer. The age-specific threshold
    identified fewer high-risk prostate cancers, but fewer men received unnecessary biopsy.
    Conclusion: There is no benefit to using reference ranges for “normal” PSA that change with age nor the age-specific thresholds
    suggested by the NICE guidelines. While the age-varying thresholds are more discriminatory, too many high-risk
    cancers are missed.

    Full details in the University publications repository