Assessments of PSA Forms and hK2 as Very Early Predictors of Prostate Cancer

Research output: ThesisDoctoral Thesis (compilation)


Concentrations of prostate-specific antigen (PSA) and human kallikrein 2 (hK2) were investigated in blood samples that had been obtained from men who were diagnosed with prostate cancer (PCa) decades later. The studies were based on a cohort comprising 22,444 men who, in 1974?1986, were early middle aged and represented a non-PCa-screened population. The results clearly demonstrate a very strong correlation between levels of all biomarkers and later PCa diagnosis. Moreover, the PSA forms and hK2 detected in the samples from men who had developed PCa were significantly increased as early as 25 years before diagnosis. Analysis also showed that even a unit increase in total PSA was associated with subsequent diagnosis. This effect of total PSA was decreased among older men (aged 60), whereas hK2 and percent free PSA were less dependent on age. A significant relationship was found between levels of hK2 and time to diagnosis. However, adding the annual rate of increase in PSA to a predictive model did not improve the accuracy compared to that achieved using a single PSA value. Finally, reanalysis of the data on the men with clinically significant disease (i.e., metastases or ? stage T3 PCa at diagnosis) showed that 93% of those individuals were among the 20% of the subjects with the highest PSA levels. Accordingly, the present findings demonstrate that all men should undergo PSA testing before the age of 50, but only the 20% found to have the highest PSA levels should immediately be assigned to further screening.
Original languageEnglish
Awarding Institution
  • Clinical Chemistry, Malmö
  • Becker, Charlotte, Supervisor
Award date2007 May 15
ISBN (Print)978-91-85559-14-5
Publication statusPublished - 2007

Bibliographical note

Defence details

Date: 2007-05-15
Time: 10:15
Place: N/A

External reviewer(s)

Name: [unknown], [unknown]
Title: [unknown]
Affiliation: [unknown]


<div class="article_info">David Ulmert, Charlotte Becker, Jan-Åke Nilsson, Timo Piironen, Thomas Björk, Jonas Hugosson, Göran Berglund and Hans Lilja. <span class="article_issue_date">2006</span>. <span class="article_title">Reproducibility and Accuracy of Measurements of Free and Total Prostate-Specific Antigen in Serum vs Plasma after Long-Term Storage at -20°C.</span> <span class="journal_series_title">Clinical Chemistry</span>, <span class="journal_volume">vol 52</span> <span class="journal_pages">pp 235-239</span>. <span class="journal_distributor">AACC</span></div>
<div class="article_info">Hans Lilja, David Ulmert, Thomas Björk, Angel Serio, Jan-Åke Nilsson, Per-Anders Abrahamsson, Andrew Vickers and Göran Berglund. <span class="article_issue_date">2007</span>. <span class="article_title">Long-Term Prediction of Prostate Cancer Up to 25 Years Before Diagnosis of Prostate Cancer Using Prostate Kallikreins Measured at Age 44 to 50 Years</span> <span class="journal_volume">vol 25</span> <span class="journal_pages">pp 431-436</span>. <span class="journal_distributor">American Society of Clinical Oncology.</span></div>
<div class="article_info">Andrew Vickers, David Ulmert, Angel Serio, Thomas Björk, Peter Scardino, James Eastham, Göran Berglund and Hans Lilja. <span class="article_issue_date"></span>. <span class="article_title">The predictive value of prostate cancer biomarkers depends on age and time to diagnosis: towards a biologically-based screening strategy.</span> (submitted)</div>
<div class="article_info">David Ulmert, Angel Serio, Matthew O'Brian, James Eastham, Peter Scardino, Thomas Björk, Göran Berglund and Hans Lilja. <span class="article_issue_date"></span>. <span class="article_title">PSA velocity does not aid long-term prediction of prostate cancer in a large, representative, unscreened population.</span> (submitted)</div>
<div class="article_info">David Ulmert, Angel Serio, Thomas Björk, Peter Scardino, James Eastham, Charlotte Becker, Göran Berglund, Andrew Vickers and Hans Lilja. <span class="article_issue_date"></span>. <span class="article_title">A single measurement of prostate-specific antigen during early middle-age identifies those men at risk for prostate cancer death</span> (manuscript)</div>

Subject classification (UKÄ)

  • Medicinal Chemistry


  • Prostate Cancer Screening
  • PSA
  • Prostate Cancer
  • Klinisk kemi
  • Clinical chemistry
  • Early Detection
  • hK2


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