• University of Strathclyde Institute of Global Public Health at iPRI, Lyon, France; International Prevention Research Institute (iPRI), Lyon, France. Electronic address: mathieu.boniol@i-pri.org.
• University of Strathclyde Institute of Global Public Health at iPRI, Lyon, France; International Prevention Research Institute (iPRI), Lyon, France.
• Department of Urology, CHU Lyon-Sud, Pierre-Benite, France.

OBJECTIVE: To investigate variations in prostate-specific antigen (PSA) levels among men with an initial normal PSA level in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial study.

METHODS: Data were extracted from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial study data set on all men in the interventional arm, with 2 tests performed in a period of < 2 years and with an initial result of the first test <4 ng/mL. The range of variation between first and second tests was computed. Risks of cancer stratified on Gleason score were computed using logistic regression.

RESULTS: A total of 31,286 men had 2 PSA tests within 2 years and with an initial value < 4 ng/mL. From the first to the second test, the median variation of PSA levels was 3.4% (interquartile range, -15% to +26%). The variation in PSA value was not associated with the delay between the first and the second test (P = .36), age (P = .16), body mass index (P = .41), and race (P = .12). A total of 2,781 prostate cancers were diagnosed during follow-up. Adjusting for age and initial PSA level, the risk of prostate cancer increased linearly with increasing PSA level at the second test, with an odds ratio of 1.079 (95% confidence interval, 1.058-1.101) for each percent increase in PSA level. However, the variation in PSA was not associated with a higher Gleason score (P = .95 for level variations in cancer of Gleason score < 7 vs ≥ 7).

CONCLUSION: Although an increase in PSA level over time is associated with increased risk of prostate cancer, this association is not related to more aggressive tumors.