Baseline PSA level should be used to guide future prostate cancer (PCa) screening of middle-aged men to reduce the risk of overdiagnosis and overtreatment of indolent cancers, according to investigators.

Noting the ongoing controversy over PSA screening in this population, Evan Kovac, MD, of Montefiore Medical Center in Bronx, New York, and colleagues performed a secondary analysis of 10,968 men aged 55 to 60 during 1993 to 2001 enrolled in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.

According to results published in JAMA Network Open, the incidence of clinically significant PCa within 13 actuarial years was 0.4%, 1.5%, 5.4%, 10.6%, 15.3%, and 29.5% for men with a baseline PSA of 0.49 or less, 0.50-0.99, 1.00-1.99, 2.00-2.99, 3.00-3.99, and 4.00 ng/mL and greater. Investigators defined clinically significant PCa as biopsy or pathologic Gleason score of 7 or greater, stage cT2b or pT3 greater, pathologic node-positive disease, or PCa-specific mortality.

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During the study period, only 15 men died, and 9 of these men had a baseline PSA level of 2.00 ng/mL or higher.

“These findings suggest that repeated screening can be less frequent among men aged 55 to 60 years with a low baseline PSA level (ie, <2.00 ng/mL) and possibly discontinued among those with baseline PSA levels of less than 1.00 ng/mL,” Dr Kovac’s team recommended.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Kovac E, Carlsson SV, Lilja H, et al. Association of baseline prostate-specific antigen level with long-term diagnosis of clinically significant prostate cancer among patients aged 55 to 60 years: A cecondary analysis of a cohort in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. JAMA Netw Open. 2020;3(1):e1919284. doi: 10.1001/jamanetworkopen.2019.19284