ArticleThe Journal of urology2023
Free PSA and Clinically Significant and Fatal Prostate Cancer in the PLCO Screening Trial.
Article in The Journal of urology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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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
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Pooled it
- Recent advances in discriminating prostate cancer from benign prostatic diseases in the pre-biopsy population.Medical oncology (Northwood, London, England) · 2026Review
- Association between platelet-to-lymphocyte ratio and high risk for prostate cancer among middle-aged and older US men.Scientific reports · 2026Article
- Multimodal urinary biomarker panel achieves superior prostate cancer detection accuracy and reduces unnecessary biopsies.Translational oncology · 2026Article
- Development and validation of risk-stratified biopsy decision pathways incorporating MRI and PSA-derived indicators.Annals of medicine · 2025Article
- Prostate-specific antigen levels at age 60 years and lifetime risk of lethal prostate cancer.Journal of the National Cancer Institute · 2025Article
- Usefulness of free PSA ratio to enhance detection of clinically significant prostate cancer in patients with PI-RADS<3 and PSA≤10.Prostate international · 2025Article
- Overdiagnosis and Overtreatment in Prostate Cancer.Diseases (Basel, Switzerland) · 2025Review
- A PSA SNP associates with cellular function and clinical outcome in men with prostate cancer.Nature communications · 2024Article
- Enhancing Radiotherapy Sensitivity in Prostate Cancer with Lentinan-Functionalized Selenium Nanoparticles: Mechanistic Insights and Therapeutic Potential.Pharmaceutics · 2024Article
- Development of novel nomograms for predicting prostate cancer in biopsy-naive patients with PSA < 10 ng/ml and PI-RADS ≤ 3 lesions.Frontiers in oncology · 2024Article
- Advancements and prospects of Raman spectroscopy in urological tumors: a bibliometric analysis.Lasers in medical science · 2023Review
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Authors and funding
9 authors at 4 institutions in 2 countries.
Funding
Abstract
purposeWe studied whether adding percent free PSA to total PSA improves prediction of clinically significant prostate cancer and fatal prostate cancer. MATERIALS AND
methodsA total of 6,727 men within the intervention arm of PLCO (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial) had baseline percent free PSA. Of this cohort, 475 had clinically significant prostate cancer and 98 had fatal prostate cancer. Cumulative incidence and Cox analyses were conducted to evaluate the association between percent free PSA/PSA and clinically significant prostate cancer/fatal prostate cancer. Harrell's C index evaluated predictive ability. Kaplan-Meier analysis assessed survival.
resultsMedian follow-up was 19.7 years, median baseline PSA was 1.19 ng/mL, median percent free PSA was 18%. Cumulative incidence of fatal prostate cancer for men with baseline PSA ≥2 ng/mL and percent free PSA ≤10 was 3.2% and 6.1% at 15 and 25 years, respectively, compared to 0.03% and 1.1% for men with percent free PSA >25%. In younger men (55-64 years) with baseline PSA 2-10 ng/mL, C index improved from 0.56 to 0.60 for clinically significant prostate cancer and from 0.53 to 0.64 for fatal prostate cancer with addition of percent free PSA. In older men (65-74 years), C index improved for clinically significant prostate cancer from 0.60 to 0.66, with no improvement in fatal prostate cancer. Adjusting for age, digital rectal exam, family history of prostate cancer, and total PSA, percent free PSA was associated with clinically significant prostate cancer (HR 1.05,
conclusionsIn a large U.S. screening trial, the addition of percent free PSA to total PSA in men with baseline PSA ≥2 ng/mL improved prediction of clinically significant prostate cancer and fatal prostate cancer. Free PSA should be used to risk-stratify screening and decrease unnecessary prostate biopsies.
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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.