Association between Liver Fibrosis and Serum PSA among U.S. Men: National Health and Nutrition Examination Survey (NHANES), 2001-2010

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Abstract

Background: To evaluate the association of liver fibrosis scores with PSA level among U.S. adult men overall and by race/ethnicity. Methods: Data from the National Health and Nutrition Examination Survey (NHANES), 2001-2010, were used. Males ages 40 years without a prostate cancer diagnosis and who had serum PSA, liver enzymes, albumin, and platelet counts measured as part of NHANES protocol were included. Liver fibrosis was measured using three scores: aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 index (FIB-4), and NAFLD fibrosis score (NFS). We assessed overall and race/ethnicity-stratified geometric mean PSA by fibrosis score using predictive margins by linear regression, and the association of abnormal fibrosis scores (APRI > 1, FIB-4 > 2.67, NFS > 0.676) and elevated PSA (>4 ng/mL) by logistic regression. Results: A total of 6,705 men were included. Abnormal liver fibrosis scores were present in 2.1% (APRI), 3.6% (FIB-4), and 5.6% (NFS). Men with higher fibrosis scores had lower geometric mean PSA (all Ptrend < 0.02). Men with abnormal APRI had a lower odds of PSA > 4 ng/mL [adjusted OR (aOR) = 0.33; 95% confidence interval (CI), 0.11-0.96]. Compared with men with 0 abnormal scores, those with 2 or 3 abnormal fibrosis scores had a lower odds of PSA > 4 ng/mL (aOR = 0.55; 95% CI, 0.33-0.91). The patterns were similar by race/ethnicity. Conclusions: Men of all race/ethnicities with higher liver fibrosis scores had lower serum PSA, and men with advanced fibrosis scores had a lower odds of an elevated PSA. Impact: These findings support further research to inform the likelihood of delay in prostate cancer detection in men with abnormal liver function.

Original languageEnglish (US)
Pages (from-to)1331-1338
Number of pages8
JournalCancer Epidemiology Biomarkers and Prevention
Volume28
Issue number8
DOIs
StatePublished - Jan 1 2019

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Men's Health
Nutrition Surveys
Liver Cirrhosis
Fibrosis
Serum
Blood Platelets
Transaminases
Prostatic Neoplasms
Confidence Intervals
Liver
Aspartate Aminotransferases
Platelet Count
Albumins
Linear Models
Logistic Models

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

@article{95e05ab4cbef4cf08958125683cbd686,
title = "Association between Liver Fibrosis and Serum PSA among U.S. Men: National Health and Nutrition Examination Survey (NHANES), 2001-2010",
abstract = "Background: To evaluate the association of liver fibrosis scores with PSA level among U.S. adult men overall and by race/ethnicity. Methods: Data from the National Health and Nutrition Examination Survey (NHANES), 2001-2010, were used. Males ages 40 years without a prostate cancer diagnosis and who had serum PSA, liver enzymes, albumin, and platelet counts measured as part of NHANES protocol were included. Liver fibrosis was measured using three scores: aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 index (FIB-4), and NAFLD fibrosis score (NFS). We assessed overall and race/ethnicity-stratified geometric mean PSA by fibrosis score using predictive margins by linear regression, and the association of abnormal fibrosis scores (APRI > 1, FIB-4 > 2.67, NFS > 0.676) and elevated PSA (>4 ng/mL) by logistic regression. Results: A total of 6,705 men were included. Abnormal liver fibrosis scores were present in 2.1{\%} (APRI), 3.6{\%} (FIB-4), and 5.6{\%} (NFS). Men with higher fibrosis scores had lower geometric mean PSA (all Ptrend < 0.02). Men with abnormal APRI had a lower odds of PSA > 4 ng/mL [adjusted OR (aOR) = 0.33; 95{\%} confidence interval (CI), 0.11-0.96]. Compared with men with 0 abnormal scores, those with 2 or 3 abnormal fibrosis scores had a lower odds of PSA > 4 ng/mL (aOR = 0.55; 95{\%} CI, 0.33-0.91). The patterns were similar by race/ethnicity. Conclusions: Men of all race/ethnicities with higher liver fibrosis scores had lower serum PSA, and men with advanced fibrosis scores had a lower odds of an elevated PSA. Impact: These findings support further research to inform the likelihood of delay in prostate cancer detection in men with abnormal liver function.",
author = "Anqi Wang and Mariana Lazo-Elizondo and Carter, {H Ballentine} and Groopman, {John Davis} and Nelson, {William G} and Platz, {Elizabeth A}",
year = "2019",
month = "1",
day = "1",
doi = "10.1158/1055-9965.EPI-19-0145",
language = "English (US)",
volume = "28",
pages = "1331--1338",
journal = "Cancer Epidemiology Biomarkers and Prevention",
issn = "1055-9965",
publisher = "American Association for Cancer Research Inc.",
number = "8",

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TY - JOUR

T1 - Association between Liver Fibrosis and Serum PSA among U.S. Men

T2 - National Health and Nutrition Examination Survey (NHANES), 2001-2010

AU - Wang, Anqi

AU - Lazo-Elizondo, Mariana

AU - Carter, H Ballentine

AU - Groopman, John Davis

AU - Nelson, William G

AU - Platz, Elizabeth A

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: To evaluate the association of liver fibrosis scores with PSA level among U.S. adult men overall and by race/ethnicity. Methods: Data from the National Health and Nutrition Examination Survey (NHANES), 2001-2010, were used. Males ages 40 years without a prostate cancer diagnosis and who had serum PSA, liver enzymes, albumin, and platelet counts measured as part of NHANES protocol were included. Liver fibrosis was measured using three scores: aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 index (FIB-4), and NAFLD fibrosis score (NFS). We assessed overall and race/ethnicity-stratified geometric mean PSA by fibrosis score using predictive margins by linear regression, and the association of abnormal fibrosis scores (APRI > 1, FIB-4 > 2.67, NFS > 0.676) and elevated PSA (>4 ng/mL) by logistic regression. Results: A total of 6,705 men were included. Abnormal liver fibrosis scores were present in 2.1% (APRI), 3.6% (FIB-4), and 5.6% (NFS). Men with higher fibrosis scores had lower geometric mean PSA (all Ptrend < 0.02). Men with abnormal APRI had a lower odds of PSA > 4 ng/mL [adjusted OR (aOR) = 0.33; 95% confidence interval (CI), 0.11-0.96]. Compared with men with 0 abnormal scores, those with 2 or 3 abnormal fibrosis scores had a lower odds of PSA > 4 ng/mL (aOR = 0.55; 95% CI, 0.33-0.91). The patterns were similar by race/ethnicity. Conclusions: Men of all race/ethnicities with higher liver fibrosis scores had lower serum PSA, and men with advanced fibrosis scores had a lower odds of an elevated PSA. Impact: These findings support further research to inform the likelihood of delay in prostate cancer detection in men with abnormal liver function.

AB - Background: To evaluate the association of liver fibrosis scores with PSA level among U.S. adult men overall and by race/ethnicity. Methods: Data from the National Health and Nutrition Examination Survey (NHANES), 2001-2010, were used. Males ages 40 years without a prostate cancer diagnosis and who had serum PSA, liver enzymes, albumin, and platelet counts measured as part of NHANES protocol were included. Liver fibrosis was measured using three scores: aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 index (FIB-4), and NAFLD fibrosis score (NFS). We assessed overall and race/ethnicity-stratified geometric mean PSA by fibrosis score using predictive margins by linear regression, and the association of abnormal fibrosis scores (APRI > 1, FIB-4 > 2.67, NFS > 0.676) and elevated PSA (>4 ng/mL) by logistic regression. Results: A total of 6,705 men were included. Abnormal liver fibrosis scores were present in 2.1% (APRI), 3.6% (FIB-4), and 5.6% (NFS). Men with higher fibrosis scores had lower geometric mean PSA (all Ptrend < 0.02). Men with abnormal APRI had a lower odds of PSA > 4 ng/mL [adjusted OR (aOR) = 0.33; 95% confidence interval (CI), 0.11-0.96]. Compared with men with 0 abnormal scores, those with 2 or 3 abnormal fibrosis scores had a lower odds of PSA > 4 ng/mL (aOR = 0.55; 95% CI, 0.33-0.91). The patterns were similar by race/ethnicity. Conclusions: Men of all race/ethnicities with higher liver fibrosis scores had lower serum PSA, and men with advanced fibrosis scores had a lower odds of an elevated PSA. Impact: These findings support further research to inform the likelihood of delay in prostate cancer detection in men with abnormal liver function.

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