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Predictive value of prostate specific antigen in a European HIV-positive cohort: does one size fit all?

Shepherd, L; Borges, ÁH; Ravn, L; Harvey, R; Bower, M; Grulich, A; Silverberg, M; ... EuroSIDA in EuroCOORD, ; + view all (2016) Predictive value of prostate specific antigen in a European HIV-positive cohort: does one size fit all? Antiviral Therapy , 21 pp. 529-534. 10.3851/IMP3026. Green open access

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Abstract

BACKGROUND: It is common practice to use PSA≥4.0 µg/L as a clinical indicator for men at risk of PCa, however this is unverified in HIV + men. We aimed to describe kinetics and predictive value of PSA for prostate-cancer (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[SHB]. Conditional logistic regression models investigated associations between markers and PCa. Mixed models were used to describe kinetics. Sensitivity and specificity of using tPSA >4 µg/L to predict PCa was calculated. ROC curves were used to identify optimal cut-offs 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 2-fold-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>4ng/mL had 99% specificity and 38% sensitivity. The optimal PSA cut-off was 1.5ng/mL overall (specificity=84%, sensitivity=81%). CONCLUSIONS: PSA was highly predictive of PCa in HIV+ men; however the commonly used PSA>4ng/mL to indicate high PCa risk was not sensitive in our population and use of the lower cut-off of PSA>1.5ng/mL warrants consideration.

Type: Article
Title: Predictive value of prostate specific antigen in a European HIV-positive cohort: does one size fit all?
Open access status: An open access version is available from UCL Discovery
DOI: 10.3851/IMP3026
Publisher version: http://dx.doi.org/10.3851/IMP3026
Language: English
Additional information: 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, (Advanced Publication), 29 January 2016, © 2016 International Medical Press.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/1476577
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