Predicting Long-Term Risk for Prostate Cancer Mortality Following a Prostate-Specific Antigen Screening Test: Prognostic Model Development and External Validation

BACKGROUND: Despite the scale of prostate-specific antigen (PSA) testing for prostate cancer (PCa) screening, prediction models do not predict time-to-event end points or adjust for patient life expectancy. OBJECTIVE: To develop, externally validate, and compare to existing tools a novel prognostic model for risk for prostate cancer-specific mortality (PCSM) after a PSA test. DESIGN: Prognostic model development in the PCa screening group of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial; external validation in a Veterans Affairs (VA) population of patients undergoing PSA testing. SETTING: United States. PLCO patients were enrolled from 1993 to 2001, and VA patients underwent PSA testing from 2002 to 2006. Survival follow-up was updated through 2022 in both cohorts. PATIENTS: = 174 787). MEASUREMENTS: The model's predicted outcome is PCSM at a specified time point; predictors included PSA level, family history of PCa, and race. Predictors of other-cause mortality included age; body mass index; smoking status; and presence of hypertension, diabetes, or stroke. RESULTS: = 0.031). LIMITATION: The model may not be generalizable to more contemporary PSA screening practices given the periods studied. CONCLUSION: This PCSM prognostic model was developed from long-term clinical trial data, was externally validated in a large national cohort, and may be used to improve interpretation of PSA results. PRIMARY FUNDING SOURCE: None.