Eur Urol: Does a smaller age at the time of prostate-specific antigen detection reduce prostate cancer mortality?

The risk of death from prostate cancer (PC) depends on age, but the age at which prostate-specific antigen (PSA) screening to start is uncertain
.

Recently, researchers from the United States published an article in Eur Urol investigating the relationship between the risk of PC death and age at the time of the first PSA screening.

Men aged 50 to 70 years were recruited and screened biennially for PSA (n=10,000), and the control group did not undergo these screenings but had the opportunity to undergo PSA testing (n=10,000).

That is, the intervention studied was regular or opportunistic PSA screening or no PSA screening
.
The researchers modeled a nonlinear relationship between the age of initiation of screening and the absolute risk reduction in PC mortality in three scenarios:

(1) intention-to-intention screening (randomized group);

(2) historical controls (screening group and data registered between 1990 and 1994);

(3) Participants only (screened participants and matched controls).

The researchers examined whether the effect of PSA screening on PC mortality depended on the age at which screening was started (intentional screening versus participants only)
by comparing survival models (with or without an interaction between the experimental group and age).

The findings found that the younger the age at which PSA testing was started, the greater the reduction in PC mortality
.
Starting screening at age 55 halves the risk of death from PC compared to getting a PSA test for the first time at age 60
.
For the cohort as a whole, the association test between age at initiation of screening and the effect of screening on PC mortality was slightly higher than the conventional statistically significant level (p=0.
052) and statistically significant in the participant-only situation (p=0.
002).

There are limitations
to this study due to the low number of disease-specific deaths among men who start screening before age 55 years and the difficulty of distinguishing the effect of age at initiation and duration of screening.

Statistics on age at initiation of PSA screening and an absolute risk reduction in PC mortality

In summary, screening for prostate PSA levels starting at age 50 to 55 years of age can significantly reduce the risk of PC death and is more
effective than previously estimated.

Original source:

Sigrid V Carlsson， Rebecka Arnsrud Godtman， Carl-Gustav Pihl et al.
Young Age on Starting Prostate-specific Antigen Testing Is Associated with a Greater Reduction in Prostate Cancer Mortality： 24-Year Follow-up of the G？ teborg Randomized Population-based Prostate Cancer Screening Trial.
Eur Urol.
Nov 2022