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Age‐specific reference range of prostate‐specific antigen and prostate cancer detection in population‐based screening cohort in J apan: Verification of J apanese U rological A ssociation G uideline for prostate cancer
Author(s) -
Kitagawa Yasuhide,
Izumi Kouji,
Sawada Kiyoshi,
Mizokami Atsushi,
Nakashima Kazuyoshi,
Koshida Kiyoshi,
Nakashima Takao,
Miyazaki Kimiomi,
Namiki Mikio
Publication year - 2014
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12523
Subject(s) - medicine , prostate specific antigen , prostate cancer , prostate , receiver operating characteristic , antigen , cancer , population , prostate cancer screening , cohort , oncology , percentile , reference range , urology , immunology , environmental health , statistics , mathematics
Objectives To investigate the age‐specific reference range of prostate‐specific antigen and clinical characteristics of screening‐detected cancer in prostate‐specific antigen‐based screening, and to verify the age‐specific prostate‐specific antigen cut‐offs in the J apanese U rological A ssociation G uidelines. Methods Prostate‐specific antigen distributions were estimated in a total of 69 028 screening tests according to the age of the participants in population screening from 2000 to 2013. The age‐specific reference range of prostate‐specific antigen for detection of cancer was investigated by analyzing the receiver operating characteristic curves. Furthermore, the clinicopathological features of screening‐detected cancer with serum prostate‐specific antigen levels below the age‐specific prostate‐specific antigen cut‐off in the J apanese U rological A ssociation G uidelines were also investigated. Results Of all 69 028 screens, 2053 prostate biopsies (2.97%) were carried out and 549 cases of cancer (0.79%) were diagnosed. The 95th percentiles in all participants aged 54–59, 60–64, 65–69 and 70–75 years old were 2.90, 3.60, 4.10, and 4.70 ng/mL, respectively. The optimal prostate‐specific antigen cut‐offs for cancer detection determined from the receiver operating characteristic curves were 2.3 and 2.6 for the age ranges 54–69 and 70–75 years, respectively. These values were lower than the age‐specific cut‐offs in the J apanese U rological A ssociation G uidelines. Of all 137 patients with prostate‐specific antigen levels below the age‐specific cut‐offs in the J apanese U rological A ssociation G uidelines, 80 (58.4%) had unfavorable clinicopathological features as active surveillance criteria. Conclusions The age‐specific reference range of prostate‐specific antigen might be lower than that recommended in the J apanese U rological A ssociation G uidelines. An individualized and natural history‐adjusted screening system should be established for screening participants with low prostate‐specific antigen level.