Age-Adjusted Reference Values for Prostate Specific Antigen – A Systematic Review and Meta-Analysis

Matti, Bashar; Xia, Weisi; Werf, Bert van der; Zargar‐Shoshtari, Kamran

doi:10.1016/j.clgc.2021.11.014

Cited by 14 publications

(5 citation statements)

References 53 publications

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“…One possible explanation of the results could be that perhaps alterations in the prostate histological profile are pronounced at 60-79 years of age. The current study found that prostate atypical findings were mainly observed in men aged 50-59, which agrees with Matti et al (2022) and Miyai et al (2014). The implications of this finding are that men aged 50-59 need screening for prostate diseases, possibly because they have an increased risk for prostate disease.…”

Section: Discussionsupporting

confidence: 83%

Histomorphological characteristics of prostate specimens analyzed at a referral hospital in Kenya.

Musungu,

Oyieko,

Marera

et al. 2023

Anat. J. Afr.

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Background: Global shift to high energy foods is important risk factor for new variants of prostate cancer. Some prostate tumors have an indolent course while others have an aggressive course; therefore, knowledge of tumor subtypes can help in clinical decision-making based on the patient profile. Methods: The main aim of the study was to determine the histomorphological characteristics of prostate specimens analyzed at regional referral hospital. The study was a crosssectional retrospective study. The target specimens in this study consisted of prostate specimens that had prostate specific antigen level and were analyzed and reported between 2017 and 2022 at Jaramogi Odinga Oginga teaching and referral hospital, Kisumu Kenya. Results: Prostate color was not reported in eight reports. Of the 72 specimens observed, 50 (69.4%) were reported to be white, 12 (16.7%) were reported to be tan/white, 9 (12.5%) were tan brown, and 1 (1.4%) was tan grey. There was significant variation (p=0.001) in prostate specimen color. Of the 80 specimens, 47 (58.75%) had coarse surface, 16(20.00%) nodulated surfaces and 17 (21.25%) shrunken surfaces. There was variation in prostate surfaces (p<0.00001, X2=23.275). Majority of specimens 55 (68.8%) measured between 0-29 mm, 12 (15%) measured 30-59 mm, 7 (8.8%) measured 60-89, 3 (3.8%) measured 90-119, 2 (2.5%) measured >150 mm and 1 (1.3%) measured 120-149 mm. There was no significant difference in the prostate biopsy sizes in comparison to the mean (p=0.984, t=0.020, 95% CI). The majority 20 (25%), of specimens had prostate cancer 15 (18.75%) had atypical findings, and 2 (2.5%) had high-grade proliferative intraepithelial neoplasia. The microscopic features of the groups did not differ significantly (F2, 34 = 1.469, p = 0.244). There is positive correlation between Gleason scores and Prostate specific antigen levels (p = 0.004, r = 0.474). Conclusion: There is variation of specimen color in prostate specimen with prostate cancer implying that advanced prostate disease causes changes in prostate color. Atypical prostate findings are common in age 50-59 which may suggest that targeted prevention and intervention should focus on this age group. Higher Gleason scores are likely to be observed in patients with higher PSA levels among patients being evaluated for prostate tumors.

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Section: Discussionsupporting

confidence: 83%

Histomorphological characteristics of prostate specimens analyzed at a referral hospital in Kenya.

Musungu,

Oyieko,

Marera

et al. 2023

Anat. J. Afr.

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“…Therefore, their potential impact on the cut-off value could be ignored. However, the heterogeneity of the population, including cross-racial and intra-racial heterogeneity, could indeed affect the choice of cut-off values between different population and subgroups by ages and races [ 47 , 48 ]. Analytical variability could also lead to different cut-off values between different subgroups within the same population, especially in the context of small sample size.…”

Section: Discussionmentioning

confidence: 99%

Risk-stratified multi-round PSA screening for prostate cancer integrating the screening reference level and subgroup-specific progression indicators

et al. 2023

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Background Although prostate-specific antigen (PSA) is widely used in prostate cancer (PCa) screening, nearly half of PCa cases are missed and less than one-third of cases are non-lethal. Adopting diagnostic criteria in population-based screening and ignoring PSA progression are presumed leading causes. Methods A total of 31,942 participants with multi-round PSA tests from the PLCO trial were included. Time-dependent receiver-operating-characteristic curves and area under curves (tdAUCs) were performed to determine the screening reference level and the optimal subgroup-specific progression indicator. Effects of risk-stratified multi-round PSA screening were evaluated with multivariable Cox regression and measured with hazard ratio [HR (95%CIs)]. Results After a median follow-up of 11.6 years, a total of 3484 PCa cases and 216 PCa deaths were documented. The tdAUC of 10-year incidence PCa with PSA was 0.816, and the cut-off value was 1.61 ng/ml. Compared to subgroup with stable negative PSA in both first-round (FR) and last-round (LR) tests [FR(−)/LR(−)], HRs (95%CI) of PCa incidence were 1.66 (1.20–2.29), 8.29 (7.25–9.48), and 14.52 (12.95–16.28) for subgroups with loss of positive PSA[FR(+)/LR(−)], gain of positive PSA[FR(−)/LR(+)], and stable positive PSA[FR(+)/LR(+)]; while HRs(95%CI) of PCa mortality were 1.47 (0.52–4.15), 5.71 (3.68–8.86), and 5.01 (3.41–7.37). After excluding regressive PSA [(namely FR(+)/LR(−)], absolute velocity was the shared optimal progression indicator for subgroups with FR(−)/LR(−), FR(−)/LR(+), and FR(+)/LR(+), with tdAUCs of 0.665, 0.681 and 0.741, and cut-off values of 0.07, 0.21, and 0.33 ng/ml/year. After reclassifying participants into groups with positive and negative progression based on subgroup-specific progression indicators, incidence HR (95%CI) were 2.41 (1.87–3.10), 2.91 (2.43–3.48), and 3.16 (2.88–3.46) for positive progression compared to negative progression within subgroups of FR(−)/LR(−), FR(−)/LR(+), and FR(+)/LR(+), while mortality HR (95%CI) were 2.22 (0.91–5.38), 2.37 (1.28–4.38), and 2.98 (1.94–4.59). To improve screening performances by excluding regressive PSA and low-risk positive progression in FR(−)/LR(−), optimized screening strategy not only significantly reduce 32.4% of missed PCa (54.0% [1881/3484] vs. 21.6% [754/3484], P < 0.001), but also detected additional 8.0% of high-grade PCa (Gleason score 7–10: 36.0% [665/1849] vs. 28.0% [206/736], P < 0.001) than traditional screening strategy. Conclusions Risk-stratified multi-round PSA screening strategy integrating the screening reference level and the optimal subgroup-specific progression indicator of PSA could be recommended as a fundamental strategy to reduce missed diagnosis and improve the detection of high-grade PCa cases.

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“…Ethnicity was found to be a source of significant heterogeneity in a recent systematic review assessing age-adjusted reference ranges in apparently healthy men: controlling for ethnicity in 10-year age intervals reduced study heterogeneity by 13% from 99% ( I 2 statistic) [ 16 ]. The remaining heterogeneity may have been explained, in part, by differences in inter-country cultures and healthcare systems, which was not controlled for.…”

Section: Discussionmentioning

confidence: 99%

“…These guidelines recommend that men with a PSA above age-specific thresholds should be offered investigation and referral for suspected prostate cancer, but does not take into account the patient’s ethnicity. A recent systematic review found ethnicity to be a considerable source of heterogeneity when assessing age-adjusted PSA reference ranges and concluded ethnicity should be considered when clinically assessing PSA levels [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Ethnic differences in prostate-specific antigen levels in men without prostate cancer: a systematic review

Barlow

Down

Mounce

et al. 2022

Prostate Cancer Prostatic Dis

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Introduction Black men are twice as likely to be diagnosed with prostate cancer than White men. Raised prostate-specific antigen (PSA) levels can indicate an increased risk of prostate cancer, however it is not known whether PSA levels differ for men of different ethnic groups. Methods PubMed and Embase were searched to identify studies that reported levels of PSA for men of at least two ethnic groups without a prostate cancer diagnosis or symptoms suggestive of prostate cancer. An adaptation of the Newcastle-Ottawa scale was used to assess risk of bias and study quality. Findings were stratified into the following broad ethnic groups: White, Black, Asian, Hispanic, and Other. Data were analysed in a narrative synthesis due to the heterogeneity of reported PSA measures and methods in the included studies. Results A total of 654 197 males from 13 studies were included. By ethnicity, this included 536 201 White (82%), 38 287 Black (6%), 38 232 Asian (6%), 18 029 Pacific Island (3%), 13 614 Maori (2%), 8 885 Hispanic (1%), and 949 Other (<1%) men aged ≥40 years old. Black men had higher PSA levels than White men, and Hispanic men had similar levels to White men and lower levels than Black men. Conclusions Black men without prostate cancer have higher PSA levels than White or Hispanic men, which reflects the higher rates of prostate cancer diagnosis in Black men. Despite that, the diagnostic accuracy of PSA for prostate cancer for men of different ethnic groups is unknown, and current guidance for PSA test interpretation does not account for ethnicity. Future research needs to determine whether Black men are diagnosed with similar rates of clinically significant prostate cancer to White men, or whether raised PSA levels are contributing to overdiagnosis of prostate cancer in Black men.

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Age-Adjusted Reference Values for Prostate Specific Antigen – A Systematic Review and Meta-Analysis

Cited by 14 publications

References 53 publications

Histomorphological characteristics of prostate specimens analyzed at a referral hospital in Kenya.

Histomorphological characteristics of prostate specimens analyzed at a referral hospital in Kenya.

Risk-stratified multi-round PSA screening for prostate cancer integrating the screening reference level and subgroup-specific progression indicators

Ethnic differences in prostate-specific antigen levels in men without prostate cancer: a systematic review

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