Kathryn Barry

Ph.D., M.P.H.

University of Maryland School of Medicine

Assistant Professor

PLCO (Learn more about this study)

PLCO-261

Mar 1, 2017

PSA velocity and prostate cancer mortality in the PLCO Cancer Screening Trial

Prostate cancer is the leading cause of cancer incidence and the second leading cause of cancer mortality among men in the U.S. (Siegel et al, 2017). The use of the prostate-specific antigen (PSA) test for prostate cancer screening remains controversial based on the observation of little to no benefit of PSA screening on prostate cancer mortality in two large randomized controlled trials (Pinksy et al, 2017, Schroder et al, 2014) and the estimated overdiagnosis and overtreatment associated with this test (Etzioni et al, 2007). Whereas the U.S. Preventive Services Task Force recommends against PSA-based screening (grade of “D”), the American Urological Association recognizes the potential benefit in particular groups (e.g., certain age/risk groups) and recommends shared decision making between the patient and provider for those subgroups of the population.

A number of epidemiological studies have investigated the relationship between prostate cancer outcomes and PSA dynamics (e.g., velocity and doubling time) after diagnosis/treatment, but relatively few studies have investigated this relationship for PSA measurements taken prior to diagnosis (Carter et al, 2006; D’Amico et al, 2004; D’Amico et al, 2005; O’Brien et al, 2011). A previous analysis in PLCO identified a significant association between pre-diagnostic PSA velocity and aggressive prostate cancer (Pinsky et al, 2007). Following up on these results, we propose to evaluate the association between pre-diagnostic PSA velocity and prostate cancer mortality in PLCO.

For the present study, we propose to make use of longitudinal pre-diagnostic PSA measurements available for men in the screening arm of PLCO. We will explore several different models to evaluate the association between PSA level, PSA velocity and prostate cancer mortality, taking into account other factors, such as age, stage, grade (Gleason score) and primary prostate cancer treatment.