• Signe Benzon Larsen, Klaus Brasso, Peter Iversen, Jane Christensen, Michael Christiansen, Sigrid Carlsson, Hans Lilja, Søren Friis, Anne Tjønneland, and Susanne Oksbjerg Dalton.
• Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark. benzon@cancer.dk
• Eur. J. Cancer. 2013 Sep 1; 49 (14): 3041-8.

AimAlthough prostate-specific antigen (PSA) screening reduces mortality from prostate cancer, substantial over-diagnosis and subsequent overtreatment are concerns. Early screening of men for PSA may serve to stratify the male population by risk of future clinical prostate cancer.Methods And MaterialCase-control study nested within the Danish 'Diet, Cancer and Health' cohort of 27,179 men aged 50-64 at enrolment. PSA measured in serum collected at cohort entry in 1993-1997 was used to evaluate prostate cancer risk diagnosed up to 14 years after. We identified 911 prostate cancer cases in the Danish Cancer Registry through 31st December 2007 1:1 age-matched with cancer-free controls. Aggressive cancer was defined as ≥ T3 or Gleason score ≥ 7 or N1 or M1. Statistical analyses were based on conditional logistic regression with age as underlying time axis.ResultsTotal PSA and free-to-total PSA ratio at baseline were strongly associated with prostate cancer risk up to 14 years later. PSA was grouped in quintiles and free-to-total PSA ratio divided in three risk groups. The incidence rate ratio for prostate cancer was 150 (95% confidence interval, 72-310) among men with a total PSA in the highest quintile (> 5.1 ng/ml) compared to the lowest (< 0.80 ng/ml). The risk of aggressive cancer was highly elevated in men with a PSA level in the highest quintile. The results indicate that one-time measurement of PSA could be used in an individualised screening strategy, sparing a large proportion of men from further PSA-based screening.Copyright © 2013 Elsevier Ltd. All rights reserved.

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