Joint modelling of PSA dynamics and prostate cancer risks: A population-based study in men without prior prostate cancer

Birzhan Akynkozhayev, Benjamin Christoffersen, Anna Lantz, Tobias Nordström, Keith Humphreys and Mark Clements

PLOS ONE, 2026, vol. 21, issue 7, 1-12

Abstract: While the prostate-specific antigen (PSA) test is a widely used prostate cancer screening tool, its application remains controversial. Opportunistic PSA testing generates complex data in which testing intensities, PSA levels, and prostate cancer diagnosis are interdependent. Conventional analyses rarely model these processes jointly. The objective of this study was to develop a population-based joint model to analyse PSA dynamics, retesting patterns, and prostate cancer risk. We used the Stockholm Prostate Cancer Diagnostics Register to identify 506,761 men with at least one PSA test between 2003 and 2020. We fitted a joint model linking three components: a linear mixed-effects submodel for PSA over age, and two proportional hazards submodels for time to next PSA test and time to prostate cancer diagnosis. PSA increased nonlinearly with age, with substantial between-person heterogeneity and increasing unexplained variation with increasing age. Estimates from models fitted to each time-to-event process separately were attenuated relative to the joint model: hazard ratios per doubling of PSA were 1.61 (95% CI: 1.59-1.62; P

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0343751

DOI: 10.1371/journal.pone.0343751

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