MP09-18: Longitudinal Outcomes Following Implementation of Baseline PSA Risk Stratification of Men in Their Forties

Zoe Michael*, Srinath Kotamarti, Rohith Arcot, Kostantinos Morris, Anand Shah, John Anderson, Andrew Armstrong, Rajan Gupta, Glenn M. Preminger, Judd W. Moul, Kevin Oeffinger, Kevin Shah, Thomas J. Polascik, Durham, NC

Introduction: A baseline prostate-specific antigen (PSA) in a man’s forties can assess risk for lethal prostate cancer (PCa) at a time in life when PSA should be low with few confounders. We examined the initial longitudinal outcomes of young men with an elevated baseline PSA screened within a system-wide primary care network.

Methods: We assessed patients within the Duke Primary Care Network ages 40-49 with a PSA following implementation of an electronic health record (EHR) screening algorithm on 2/2/2017.  The outcomes of men with PSA > 1.5 ng/ml were assessed through 7/2021. Statistical analyses compared mean PSAs between groups and identified factors associated with the detection of all PCa and clinically significant PCa (csPCa), defined as Gleason Grade Group (GGG) > 2.

Results: Of 49,980 men screened, 11,922 men were ages 40-49, with 564 (4.7%) found to have a PSA > 1.5 ng/ml. A total of 330 (58.5%) men were referred to urology for PCa suspicion, while the remaining 234 (41.5%) were either not referred to urology (n=206) or were referred for reasons unrelated to PCa suspicion (n=28).  Referred patients had significantly higher mean PSA values (2.97 vs 1.98, p=0.001).  In the entire cohort, 49 patients (8.7%) underwent biopsy; of these, 20 (40.8%) returned positive for PCa.  A total of 11 men had csPCa, including three patients with > GGG4.  Timing of referral and PSA levels were significantly associated with all PCa at biopsy on multivariable analysis.  However, a separate analysis for csPCa showed PSA was a significant predictor (OR 1.065, p<0.05), while referral timing was not (p>0.05).

Conclusions: A PSA > 1.5 ng/ml led to PCa diagnosis in a small but important percentage of men in their forties.  Overall, this study provides validation for a baseline PSA measurement in younger men to determine those patients harboring lethal cancer who could benefit from potentially lifesaving intervention.  Further work is needed to enhance PCP buy-in and optimize coordination between PCPs and urologists to further improve patient care.

Source of Funding: Grants from the National Cancer Institute and the Duke Institute for Health Innovation (DIHI)