{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T09:10:25Z","timestamp":1792746625029,"version":"4.5.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"\n Importance<\/jats:title>\n Repeating a prostate-specific antigen (PSA) test after an elevated measurement is a guideline-recommended component of the prebiopsy workup. However, it is unclear whether certain patients can be exempted from repeat PSA testing and proceed directly to further workup.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine yearly PSA variability and implications of repeating an elevated PSA in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective multicenter cohort study used data from men aged 54 to 75 years participating in the screening arm of the randomized PLCO trial who received PSA testing annually over 6 years (between 1995 and 2006) without a prostate cancer diagnosis. Data were analyzed from February 10, 2023, to May 23, 2025.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the proportion of PSA measurements above 1 of the 3 biopsy thresholds of interest (2.5, 3.0, and 4.0 ng\/mL) that decreased below the threshold at the subsequent yearly measurement. Analyses were conducted at both the PSA test and patient levels.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 11\u202f176 eligible patients (median age 60 years, IQR, 57-65 years), 2700 patients were included at a threshold of 2.5 ng\/mL, 1928 patients at 3.0 ng\/mL, and 952 patients at 4.0 ng\/mL at least once. Among PSA measurements greater than or equal to 2.5 ng\/mL, 22% (95% CI, 21%-23%) decreased below 2.5 ng\/mL the following year; rates were similar for thresholds of 3.0 ng\/mL and 4.0 ng\/mL. At the patient level, 54% (95% CI, 53%-56%) of men with at least 1 PSA greater than or equal to 2.5 ng\/mL had a subsequent level below this threshold, with slightly greater rates for the higher thresholds. A predictive scoring system incorporating current and prior PSA levels showed that patients with PSA levels persistently above thresholds had a low (&amp;lt;10%) probability of PSA decreasing below the threshold.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this study, significant intra-individual variability in PSA levels was observed in this large screening cohort, with many elevated values falling below the threshold at the next yearly measurement. These findings suggest the utility of guideline recommendations to confirm elevated PSA results in most patients before performing further diagnostic evaluation and that patients with a prior PSA score above a given biopsy threshold, and no recent PSA scores below that threshold, could proceed to further diagnostic evaluation without repeat testing.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoncol.2025.3386","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T15:01:16Z","timestamp":1758207676000},"page":"1341","source":"Crossref","is-referenced-by-count":5,"title":["Prostate-Specific Antigen Levels Among Participants Receiving Annual Testing"],"prefix":"10.1001","volume":"11","author":[{"given":"Nicholas A.","family":"Pickersgill","sequence":"first","affiliation":[{"name":"Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria M.","family":"Per\u00e9","sequence":"additional","affiliation":[{"name":"Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily A.","family":"Vertosick","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunny","family":"Nalavenkata","sequence":"additional","affiliation":[{"name":"Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e1rbara","family":"Vieira Lima Aguiar Mel\u00e3o","sequence":"additional","affiliation":[{"name":"Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Vickers","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Lilja","sequence":"additional","affiliation":[{"name":"Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, New York"},{"name":"Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York"},{"name":"Department of Translational Medicine, Lund University, Malm\u00f6, Sweden"},{"name":"Department of Medicine (GU-Oncology Service), Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Eastham","sequence":"additional","affiliation":[{"name":"Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid V.","family":"Carlsson","sequence":"additional","affiliation":[{"name":"Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, New York"},{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York"},{"name":"Department of Translational Medicine, Lund University, Malm\u00f6, Sweden"},{"name":"Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"17","key":"coi250055r1","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.1056\/NEJM199104253241702","article-title":"Measurement of prostate-specific antigen in serum as a screening test for prostate cancer.","volume":"324","author":"Catalona","year":"1991","journal-title":"N Engl J Med"},{"issue":"2","key":"coi250055r2","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1097\/JU.0000000000002696","article-title":"Results from 22 years of Followup in the G\u00f6teborg Randomized Population-Based Prostate Cancer Screening Trial.","volume":"208","author":"Fr\u00e5nlund","year":"2022","journal-title":"J Urol"},{"issue":"4","key":"coi250055r3","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1002\/cncr.30474","article-title":"Extended mortality results for prostate cancer screening in the PLCO trial with median follow-up of 15 years.","volume":"123","author":"Pinsky","year":"2017","journal-title":"Cancer"},{"issue":"1","key":"coi250055r4","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.eururo.2019.02.009","article-title":"A 16-yr follow-up of the European Randomized study of Screening for Prostate Cancer.","volume":"76","author":"Hugosson","year":"2019","journal-title":"Eur Urol"},{"issue":"3","key":"coi250055r5","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.eururo.2016.08.004","article-title":"Complications after systematic, random, and image-guided prostate biopsy.","volume":"71","author":"Borghesi","year":"2017","journal-title":"Eur Urol"},{"issue":"1","key":"coi250055r6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/ncpuro0702","article-title":"The responsible use of antibiotics for an elevated PSA level.","volume":"4","author":"Scardino","year":"2007","journal-title":"Nat Clin Pract Urol"},{"issue":"6","key":"coi250055r7","doi-asserted-by":"publisher","first-page":"2179","DOI":"10.1016\/S0022-5347(01)64708-6","article-title":"Biological variation of total, free and percent free serum prostate specific antigen levels in screening volunteers.","volume":"157","author":"Ornstein","year":"1997","journal-title":"J Urol"},{"issue":"11","key":"coi250055r8","doi-asserted-by":"publisher","first-page":"1769","DOI":"10.1111\/j.1464-410X.2010.09761.x","article-title":"Intra-individual short-term variability of prostate-specific antigen and other kallikrein markers in a serial collection of blood from men under evaluation for prostate cancer.","volume":"107","author":"Christensson","year":"2011","journal-title":"BJU Int"},{"issue":"2","key":"coi250055r9","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1373\/clinchem.2005.050641","article-title":"Reproducibility and accuracy of measurements of free and total prostate-specific antigen in serum vs plasma after long-term storage at -20 degrees C.","volume":"52","author":"Ulmert","year":"2006","journal-title":"Clin Chem"},{"issue":"20","key":"coi250055r10","doi-asserted-by":"publisher","first-page":"2695","DOI":"10.1001\/jama.289.20.2695","article-title":"Variation of serum prostate-specific antigen levels: an evaluation of year-to-year fluctuations.","volume":"289","author":"Eastham","year":"2003","journal-title":"JAMA"},{"issue":"8","key":"coi250055r11","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1373\/clinchem.2004.046086","article-title":"Biological variation of total prostate-specific antigen: a survey of published estimates and consequences for clinical practice.","volume":"51","author":"S\u00f6l\u00e9tormos","year":"2005","journal-title":"Clin Chem"},{"issue":"3","key":"coi250055r12","doi-asserted-by":"publisher","first-page":"236","DOI":"10.6004\/jnccn.2023.0014","article-title":"NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Prostate Cancer Early Detection, Version 2.2024.","volume":"21","author":"Moses","year":"2024","journal-title":"J Natl Compr Canc Netw"},{"issue":"2","key":"coi250055r13","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.eururo.2024.03.027","article-title":"EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, diagnosis, and local treatment with curative intent.","volume":"86","author":"Cornford","year":"2024","journal-title":"Eur Urol"},{"issue":"1","key":"coi250055r14","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/JU.0000000000002757","article-title":"Clinically localized prostate cancer: AUA\/ASTRO guideline, part i: introduction, risk assessment, staging, and risk-based management.","volume":"208","author":"Eastham","year":"2022","journal-title":"J Urol"},{"issue":"18","key":"coi250055r15","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1001\/jama.2018.3710","article-title":"Screening for prostate cancer: US Preventive Services Task Force recommendation statement.","volume":"319","author":"Grossman","year":"2018","journal-title":"JAMA"},{"issue":"13","key":"coi250055r16","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.1056\/NEJMoa0810696","article-title":"Mortality results from a randomized prostate-cancer screening trial.","volume":"360","author":"Andriole","year":"2009","journal-title":"N Engl J Med"},{"issue":"1","key":"coi250055r17","doi-asserted-by":"publisher","first-page":"570","DOI":"10.32614\/RJ-2021-053","article-title":"Reproducible summary tables with the gtsummary Package.","volume":"13","author":"Sjoberg","year":"2021","journal-title":"R J"},{"issue":"43","key":"coi250055r19","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.21105\/joss.01686","article-title":"Welcome to the Tidyverse.","volume":"4","author":"Wickham","year":"2019","journal-title":"JOSS"},{"issue":"6","key":"coi250055r20","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1016\/j.eururo.2013.05.049","article-title":"Systematic review of complications of prostate biopsy.","volume":"64","author":"Loeb","year":"2013","journal-title":"Eur Urol"},{"issue":"12","key":"coi250055r21","doi-asserted-by":"publisher","first-page":"1912","DOI":"10.1111\/j.1464-410X.2010.09712.x","article-title":"No excess mortality after prostate biopsy: results from the European Randomized Study of Screening for Prostate Cancer.","volume":"107","author":"Carlsson","year":"2011","journal-title":"BJU Int"},{"issue":"3","key":"coi250055r22","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1016\/j.juro.2013.08.088","article-title":"The impact of repeat biopsies on infectious complications in men with prostate cancer on active surveillance.","volume":"191","author":"Ehdaie","year":"2014","journal-title":"J Urol"},{"issue":"3","key":"coi250055r23","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.1439","article-title":"Time trends and variation in the use of active surveillance for management of low-risk prostate cancer in the US.","volume":"6","author":"Cooperberg","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"7","key":"coi250055r24","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1056\/NEJMoa1201637","article-title":"Quality-of-life effects of prostate-specific antigen screening.","volume":"367","author":"Heijnsdijk","year":"2012","journal-title":"N Engl J Med"},{"issue":"12","key":"coi250055r25","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw165","article-title":"Repeat prostate-specific antigen tests before prostate biopsy decisions.","volume":"108","author":"Nordstr\u00f6m","year":"2016","journal-title":"J Natl Cancer Inst"},{"issue":"4","key":"coi250055r26","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/j.eururo.2007.11.064","article-title":"Contribution of a single repeat PSA test to prostate cancer risk assessment: experience from the ProtecT study.","volume":"53","author":"Rosario","year":"2008","journal-title":"Eur Urol"},{"issue":"1","key":"coi250055r27","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1111\/bju.14197","article-title":"Repeat prostate-specific antigen (PSA) test before prostate biopsy: a 20% decrease in PSA values is associated with a reduced risk of cancer and particularly of high-grade cancer.","volume":"122","author":"De Nunzio","year":"2018","journal-title":"BJU Int"},{"issue":"1","key":"coi250055r28","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1038\/pcan.2008.37","article-title":"Repeating an abnormal prostate-specific antigen (PSA) level: how relevant is a decrease in PSA?","volume":"12","author":"Connolly","year":"2009","journal-title":"Prostate Cancer Prostatic Dis"},{"issue":"5","key":"coi250055r29","doi-asserted-by":"publisher","first-page":"2071","DOI":"10.1016\/j.juro.2009.01.029","article-title":"Yearly prostate specific antigen and digital rectal examination fluctuations in a screened population.","volume":"181","author":"Ankerst","year":"2009","journal-title":"J Urol"},{"issue":"5","key":"coi250055r30","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1016\/j.urology.2015.02.013","article-title":"Variation of prostate-specific antigen value in men and risk of high-grade prostate cancer: analysis of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Study.","volume":"85","author":"Boniol","year":"2015","journal-title":"Urology"},{"key":"coi250055r18","unstructured":"R Core Team. R: A language and environment for statistical computing. Published online 2021. https:\/\/www.R-project.org\/"}],"container-title":["JAMA Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/articlepdf\/2839131\/jamaoncology_pickersgill_2025_oi_250055_1763138456.64832.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T16:04:55Z","timestamp":1763654695000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/fullarticle\/2839131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,1]]},"references-count":30,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoncol.2025.3386","relation":{},"ISSN":["2374-2437"],"issn-type":[{"value":"2374-2437","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11,1]]}}}