Predicting 7-year mortality for use with evidence-based guidelines for Prostate-Specific Antigen (PSA) testing: findings from a large prospective study of 123 697 Australian men

Grace Joshy*, Emily Banks, Anthony Lowe, Rory Wolfe, Leonie Tickle, Bruce Armstrong, Mark Clements

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

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    Objectives To develop and validate a prediction model for short-term mortality in Australian men aged ≥45years, using age and self-reported health variables, for use when implementing the Australian Clinical Practice Guidelines for Prostate-Specific Antigen (PSA) Testing and Early Management of Test-Detected Prostate Cancer Implementation of one of the Guideline recommendations requires an estimate of 7-year mortality

    Design Prospective cohort study using questionnaire data linked to mortality data

    Setting Men aged ≥45years randomly sampled from the general population of New South Wales, Australia, participating in the 45 and Up Study

    Participants 123 697 men who completed the baseline postal questionnaire (distributed from 1 January 2006 to 31 December 2008) and gave informed consent for follow-up through linkage of their data to population health databases

    Primary outcome measures The primary outcome was all-cause mortality

    Results 12 160 died during follow-up (median=59 years) Following age-adjustment, self-reported health was the strongest predictor of all-cause mortality (C-index: 0827; 95% CI 0824 to 0831) Three prediction models for all-cause mortality were validated, with predictors: Model-1: Age group and self-rated health; Model-2: Variables common to the 45 and Up Study and the Australian Health Survey and subselected using stepwise regression and Model-3: All variables selected using stepwise regression Final predictions calibrated well with observed all-cause mortality rates The 90th percentile for the 7-year mortality risks ranged from 192% to 8394% for ages 45-85 years

    Conclusions We developed prediction scores for short-term mortality using age and self-reported health measures and validated the scores against national mortality rates Along with age, simple measures such as self-rated health, which can be easily obtained without physical examination, were strong predictors of all-cause mortality in the 45 and Up Study Seven-year mortality risk estimates from Model-3 suggest that the impact of the mortality risk prediction tool on men's decision making would be small in the recommended age (50-69 years) for PSA testing, but it may discourage testing at older ages.

    Original languageEnglish
    Article numbere022613
    Pages (from-to)1-12
    Number of pages12
    JournalBMJ Open
    Issue number12
    Publication statusPublished - 1 Dec 2018

    Bibliographical note

    Copyright Author(s) (or their employer(s)) 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


    • 45 and up study
    • Australian men
    • Calibration
    • Cox model
    • Life expectancy
    • Mortality prediction
    • Self-rated health
    • Validation


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