ArticleThe Journal of urology2020
Prespecified 4-Kallikrein Marker Model at Age 50 or 60 for Early Detection of Lethal Prostate Cancer in a Large Population Based Cohort of Asymptomatic Men Followed for 20 Years.
Article in The Journal of urology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 3 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- Guideline of guidelines: a critical appraisal of the evidence for PSA retesting intervals.BJU international · 2025Pooled it
- Early Detection of Prostate Cancer: AUA/SUO Guideline Part I: Prostate Cancer Screening.The Journal of urology · 2023Guideline
- Pooled it
- Population-based randomized trial of screening for clinically significant prostate cancer ProScreen: a pilot study.BJU international · 2022Trial
- Early-Onset Prostate Cancer: Epidemiology, Risk Factors, Biology, Clinical Features, Management, and Early Detection.MedComm · 2026Review
- Prostate-specific antigen levels at age 60 years and lifetime risk of lethal prostate cancer.Journal of the National Cancer Institute · 2025Article
- Performance of 4Kscore as a Reflex Test to Prostate-specific Antigen in the GÖTEBORG-2 Prostate Cancer Screening Trial.European urology · 2024Article
- Free PSA and Clinically Significant and Fatal Prostate Cancer in the PLCO Screening Trial.The Journal of urology · 2023Article
- Predictive value of kallikrein forms and β-microseminoprotein in blood from patients with evidence of detectable levels of PSA after radical prostatectomy.World journal of urology · 2023Article
- Screening for prostate cancer: evidence, ongoing trials, policies and knowledge gaps.BMJ oncology · 2023Review
- Are polygenic risk scores ready for the cancer clinic?-a perspective.Translational lung cancer research · 2022Review
- Prostate cancer polygenic risk score and prediction of lethal prostate cancer.NPJ precision oncology · 2022Article
- Effect of Bicalutamide Combined with Docetaxel on Serum PSA and VEGF Levels in Patients with Advanced Prostate Carcinoma.Disease markers · 2022Article
- Prostate Cancer Liquid Biopsy Biomarkers' Clinical Utility in Diagnosis and Prognosis.Cancers · 2021Review
- Screening for Prostate Cancer.The Medical clinics of North America · 2020Review
- Markers of Toxicity and Response to Radiation Therapy in Patients With Prostate Cancer.Advances in radiation oncologyReview
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Authors and funding
8 authors at 4 institutions in 3 countries.
Funding
Abstract
purposeA prespecified statistical model based on 4 kallikrein markers in blood, commercially available as the 4Kscore®, has been shown to accurately detect high grade (greater than Grade Group 2) prostate cancer in men with moderately elevated prostate specific antigen. We assessed whether the model predicted prostate cancer metastasis or death in men not subject to prostate specific antigen screening. MATERIALS AND
methodsThe cohort includes 43,692 unscreened prostate cancer-free men from a Swedish population based cohort with low rates of prostate specific antigen screening (Västerbotten Intervention Project). Using cryopreserved blood collected at ages 50 and 60 years from men in this cohort we analyzed the association between prostate specific antigen and other kallikrein marker levels in blood and risk of prostate cancer metastasis or death.
resultsThere were 308 with metastases and 172 prostate cancer deaths. Baseline prostate specific antigen was strongly associated with 20-year risk of prostate cancer death (c-index at age 50, 0.859, 95% CI 0.799-0.916; age 60, 0.840, 95% CI 0.799-0.878). Men 60 years old with prostate specific antigen below median (less than 1.2 ng/ml) had 0.4% risk of prostate cancer death at 20 years. Among men with moderately elevated prostate specific antigen (2.0 ng/ml or greater) the 4Kscore markedly improved discrimination (c-index 0.767 vs 0.828 and 0.774 vs 0.862 in men age 50 and 60, respectively). Long-term risk of prostate cancer death or metastasis in men with low 4Kscores was very low.
conclusionsScreening should focus on men in top prostate specific antigen quartile at age 60 years. Men with elevated prostate specific antigen but a low 4Kscore can safely be monitored with repeated blood markers in place of immediate biopsy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.