Prostate Specific Antigen Testing Among the Elderly—When To Stop?

Selection criteria for study population. High risk pCA definition 1—men who died of prostate cancer. High risk pCA definition 2—men with PSA 20 ng/ml or greater (12), Gleason score 8 or greater (5), or prostate cancer as underlying cause of death (18). BPH, benign prostatic hyperplasia.

Kernel density plot of PSA distribution for NHANES data (broken line) and BLSA (solid line) data for ages 50 to 59 (A), 60 to 69 (B), 70 to 79 (C) and 80 years or older (D). Two-sample Kolmogorov-Smirnov test was used for comparison.

Relationship between PSA and age for subjects without prostate cancer (dots), subjects with high risk prostate cancer who died of disease (closed circles), those with PSA greater than 20 ng/ml or Gleason score 8 or more (open circles), and those with prostate cancer not considered high risk (triangles). Each mark represents PSA at subject visit so that subject could be represented more than once. For simplicity figure does not show data on subjects without high risk prostate cancer who did not have PSA information before age 75 years. Lower right panel represents study group (PSA less than 3.0 ng/ml and older than 75 years).

Probability of death from prostate cancer (A). For example, probability of death from prostate cancer in subject with PSA 3 ng/ml or greater after age 70 to 75 years was approximately 7%. Probability of high risk prostate cancer (B) (death from prostate cancer, or PSA 20 ng/ml or more, or Gleason score 8 or more).

Probability plot of death (A) or development of high risk prostate cancer (B) at age 75 years with PSA cut points as indicated along x-axis. For example, probability of life threatening prostate cancer developing in subject with PSA less than 3 ng/ml was approximately 3.4%. For each of PSA cut points 95% CIs were determined using bootstrap approach. Note confidence intervals for probability of high risk disease with PSA greater than 3.5 ng/ml do not overlap with confidence intervals for lower PSAs.

Kaplan-Meier estimate of time to death from prostate cancer (A) or high risk prostate cancer (B) from first subject visit after age 75 years. Time to diagnosis of high risk prostate cancer was not significantly different between PSA categories of 3 ng/ml or more (p = 0.634). Time to diagnosis of high risk prostate cancer differed significantly for PSA less than 3 vs 3 ng/ml or greater (p = 0.019). PSA less than 3 (solid line), 3 to 3.9 (broken line) and 4 to 10 (dot dash line) ng/ml were measured at visit after age 75 years.