Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold

Roxanne Espaldon; Katharine A Kirby; Kathy Z Fung; Richard M Hoffman; Adam A Powell; Stephen J Freedland; Louise C Walter

doi:10.1016/j.urology.2013.10.051

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Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold

Journal article

Open access

Peer reviewed

Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold

Roxanne Espaldon, Katharine A Kirby, Kathy Z Fung, Richard M Hoffman, Adam A Powell, Stephen J Freedland and Louise C Walter

Urology (Ridgewood, N.J.), Vol.83(3), pp.599-605

03/2014

DOI: 10.1016/j.urology.2013.10.051

PMCID: PMC3943595

PMID: 24439009

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Abstract

To determine the distribution of screening prostate-specific antigen (PSA) values in older men, and how different PSA thresholds affect the proportion of white, black, and Latino men who would have an abnormal screening result across advancing age groups. We used linked national Veterans Affairs and Medicare data to determine the value of the first screening PSA test (ng/mL) of 327,284 men older than 65 years who underwent PSA screening in the Veterans Affairs health care system in 2003. We calculated the proportion of men with an abnormal PSA result based on age, race, and common PSA thresholds. Among men older than 65 years, 8.4% had a PSA >4.0 ng/mL. The percentage of men with a PSA >4.0 ng/mL increased with age and was highest in black men (13.8%) vs white (8.0%) or Latino men (10.0%) (P <.001). Combining age and race, the probability of having a PSA >4.0 ng/mL ranged from 5.1% of Latino men aged 65-69 years to 27.4% of black men older than 85 years. Raising the PSA threshold from >4.0 ng/mL to >10.0 ng/mL reclassified the greatest percentage of black men older than 85 years (18.3% absolute change) and the lowest percentage of Latino men aged 65-69 years (4.8% absolute change) as being under the biopsy threshold (P <.001). Age, race, and PSA threshold together affect the pretest probability of an abnormal screening PSA result. Based on screening PSA distributions, stopping screening among men whose PSA <3 ng/mL means more than 80% of white and Latino men older than 70 years would stop further screening, and increasing the biopsy threshold to >10 ng/mL has the greatest effect on reducing the number of older black men who will face biopsy decisions after screening.

United States - epidemiology

Age Factors

Cross-Sectional Studies

Humans

Probability

European Continental Ancestry Group - statistics & numerical data

Hispanic Americans - statistics & numerical data

Male

Prostatic Neoplasms - ethnology

Prostate-Specific Antigen - blood

African Americans - statistics & numerical data

Aged, 80 and over

Prostatic Neoplasms - blood

Aged

Details

Title: Subtitle: Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold
Creators: Roxanne Espaldon - Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA
Katharine A Kirby - Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA
Kathy Z Fung - Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA
Richard M Hoffman - Department of Medicine, University of New Mexico, New Mexico VA Health Care System, Albuquerque, NM
Adam A Powell - Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN
Stephen J Freedland - Durham VA Medical Center, Durham, NC; Duke Prostate Center, Duke University, Durham, NC
Louise C Walter - Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA. Electronic address: Louise.Walter@ucsf.edu
Resource Type: Journal article
Publication Details: Urology (Ridgewood, N.J.), Vol.83(3), pp.599-605
DOI: 10.1016/j.urology.2013.10.051
PMID: 24439009
PMCID: PMC3943595
NLM abbreviation: Urology
ISSN: 0090-4295
eISSN: 1527-9995
Grant note: P30 AG044281 / NIA NIH HHS K24AG041180 / NIA NIH HHS R01 CA134425 / NCI NIH HHS CDA 08-024 / HSRD VA K24 AG041180 / NIA NIH HHS
Language: English
Date published: 03/2014
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984094535002771

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