Predictive value of prostate specific antigen in a European HIV-positive cohort: does one size fit all?
Author(s)
Type
Journal Article
Abstract
Background: It is common practice to use prostate specific antigen (PSA) ≥4.0 ng/ml as a clinical indicator for men at risk of prostate cancer (PCa), however, this is unverified in HIV+ men. We aimed to describe kinetics and predictive value of PSA for PCa in HIV+ men. Methods: A nested case control study of 21 men with PCa and 40 matched-controls within EuroSIDA was conducted. Prospectively stored plasma samples before PCa (or matched date in controls) were measured for the following markers: total PSA (tPSA), free PSA (fPSA), testosterone and sex hormone binding globulin (SHBG). Conditional logistic regression models investigated associations between markers and PCa. Mixed models were used to describe kinetics. Sensitivity and specificity of using tPSA >4 ng/ml to predict PCa was calculated. Receiver operating characteristic curves were used to identify optimal cutoffs in HIV+ men for total PSA. Results: 61 HIV+ men were included with a median 6 (IQR 2–9) years follow-up. Levels of tPSA increased by 13.7% per year (95% CI 10.3, 17.3) in cases, but was stable in controls (-0.4%; 95% CI -2.5, 1.7). Elevated PSA was associated with higher odds of PCa at first (OR for twofold higher 4.7; 95% CI 1.7, 12.9; P<0.01) and last sample (8.1; 95% CI 1.1, 58.9; P=0.04). A similar relationship was seen between fPSA and PCa. Testosterone and SHBG level were not associated with PCa. tPSA level >4 ng/ml had 99% specificity and 38% sensitivity. The optimal PSA cutoff was 1.5 ng/ml overall (specificity =84%, sensitivity =81%). Conclusions: PSA was highly predictive of PCa in HIV+ men; however, the commonly used PSA>4 ng/ml to indicate high PCa risk was not sensitive in our population and use of the lower cutoff of PSA>1.5 ng/ml warrants consideration.
Date Issued
2016-01-29
Online Publication Date
2016-01-29
2017-08-17T11:20:56Z
Date Acceptance
2016-01-13
ISSN
1359-6535
Publisher
International Medical Press
Start Page
529
End Page
534
Journal / Book Title
Antiviral Therapy
Volume
21
Copyright Statement
This is the author’s version of a work accepted for publication by International Medical Press. Changes resulting from the publishing process, including peer review, editing and formatting, might not be reflected in this document. A definitive version was published in Antiviral Therapy, (21), 29 Jan 2016, © 2016 International Medical Press.
Source Database
web-of-science
Subjects
Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Pharmacology & Pharmacy
Virology
IMMUNODEFICIENCY-VIRUS-INFECTION
FOLLOW-UP
CANCER
MEN
PEOPLE
TRIAL
EuroSIDA in EuroCOORD
0605 Microbiology
1103 Clinical Sciences
1108 Medical Microbiology
Publication Status
Published