Normalised repeat serum prostate-specific antigen: associations with age and magnetic resonance imaging results

Hang Dang; Victoria  Huang; Ola Bratt

doi:10.2340/sju.v59.26662

Authors

Hang Dang Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden https://orcid.org/0009-0002-9707-9036
Victoria Huang Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden https://orcid.org/0009-0003-1276-8471
Ola Bratt Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden https://orcid.org/0000-0002-9198-9445

DOI:

https://doi.org/10.2340/sju.v59.26662

Keywords:

Prostate cancer, diagnosis, prostate-specific antigen, repeat testing, magnetic resonance imaging, age

Abstract

Objective: To assess the value of a repeat prostate-specific antigen measurement (PSA2) before magnetic resonance imaging (MRI) in men with a raised PSA (PSA1) <10 µg/L.

Method: Medical records of men aged < 75 years referred in 2021 for PSA1 3.0–9.9 µg/L (< 70 years) or 5.0–9.9 µg/L (70–74 years) were reviewed. PSA2 was sampled before MRI within 60 days from PSA1. Odds ratios (ORs) were calculated with logistic regression. Chi-square and trend-test were used for categorical variables.

Results: A total of 341 men were included. Median time between PSA1 and PSA2 was 28 days (interquartile range 20–35 days). PSA normalised in 16% (95% confidence interval [CI]: 13–21). Younger men were more likely to have a normal PSA2 (OR: 0.95 per year older, 95% CI: 0.92–0.99). Among men aged < 70 years, those with PSA1 < 5 µg/L were more likely to have normalised PSA2 than those with PSA1 ≥ 5 µg/L (21% vs. 10%, p = 0.01). A greater proportion of men with normalised PSA2 had a Prostate Imaging Data and Reporting System MRI score of 1–3 than men with non-normalised PSA2 (93% vs. 77%, p = 0.01).

Conclusions: A clinically significant proportion of men with a moderately raised PSA value have a normal PSA2. Younger men and men with lower PSA1 were more likely to have a normal PSA2. Few men with normalised PSA2 had suspicious MRI findings. Routine repeat PSA-testing may be motivated in men with a moderately raised PSA value to save MRI resources, particularly in younger men.

Downloads

Download data is not yet available.

References

Rosario DJ, Lane JA, Metcalfe C, et al. Contribution of a single repeat PSA test to prostate cancer risk assessment: experience from the ProtecT study. Eur Urol. 2008;53(4):777–84.

https://doi.org/10.1016/j.eururo.2007.11.064 DOI: https://doi.org/10.1016/j.eururo.2007.11.064

De Nunzio C, Lombardo R, Nacchia A, et al. Repeat prostatespecific antigen (PSA) test before prostate biopsy: a 20% decrease in PSA values is associated with a reduced risk of cancer and particularly of high-grade cancer. BJU Int. 2018;122(1):83–8.

https://doi.org/10.1111/bju.14197 DOI: https://doi.org/10.1111/bju.14197

Nordström T, Adolfsson J, Grönberg H, et al. Repeat prostate-specific antigen tests before prostate biopsy decisions. J Natl Cancer Inst. 2016;108(12):djw165.

https://doi.org/10.1093/jnci/djw165 DOI: https://doi.org/10.1093/jnci/djw165

Lavallée LT, Binette A, Witiuk K, et al. Reducing the harm of prostate cancer screening: repeated prostate-specific antigen testing. Mayo Clin Proc. 2016;91(1):17–22.

https://doi.org/10.1016/j.mayocp.2015.07.030 DOI: https://doi.org/10.1016/j.mayocp.2015.07.030

Xie J, Jin C, Liu M, et al. MRI/transrectal ultrasound fusion-guided targeted biopsy and transrectal ultrasound-guided systematic biopsy for diagnosis of prostate cancer: a systematic review and meta-analysis. Front Oncol. 2022;12:880336.

https://doi.org/10.3389/fonc.2022.880336 DOI: https://doi.org/10.3389/fonc.2022.880336

Bratt O, Carlsson S, Fransson P, et al. The Swedish national guidelines on prostate cancer, part 1: early detection, diagnostics, staging, patient support and primary management of non-metastatic disease. Scand J Urol. 2022;56(4):265–73.

https://doi.org/10.1080/21681805.2022.2094462 DOI: https://doi.org/10.1080/21681805.2022.2094462

Connolly D, Black A, Murray LJ, et al. Repeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA? Prostate Cancer Prostatic Dis. 2009;12(1):47–51.

https://doi.org/10.1038/pcan.2008.37 DOI: https://doi.org/10.1038/pcan.2008.37

Arsov C, Albers P, Herkommer K, et al. A randomized trial of risk-adapted screening for prostate cancer in young men – results of the first screening round of the PROBASE trial. Int J Cancer. 2022;150(11):1861–9. DOI: https://doi.org/10.1002/ijc.33940

https://doi

Kobayashi M, Kijima T, Yashi M, et al. Prostate-specific antigen kinetics contributes to decision making for biopsy referral: the predictive implication for PSA retest in patients with elevated PSA levels. Prostate Int. 2023;11(1):27–33.

https://doi.org/10.1016/j.prnil.2022.08.001 DOI: https://doi.org/10.1016/j.prnil.2022.08.001