Is additional testing necessary in men with prostate-specific antigen levels of 1.0 ng/mL or less in a population-based screening setting? (ERSPC, section Rotterdam)

Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Urology (Impact Factor: 2.19). 03/2005; 65(2):343-6. DOI: 10.1016/j.urology.2004.09.046
Source: PubMed


Currently, several prostate cancer rescreening intervals are in use in different countries worldwide, varying from 1 to 4 years. Recently, it has been proposed to determine the rescreening interval relative to the initial prostate-specific antigen (PSA) level and possibly to extend the rescreening interval up to 5 years.
We evaluated the screening results of two subsequent screening visits (4-year interval) of 1703 men aged 55 to 65 years with an initial PSA level of 1.0 ng/mL or less within a randomized screening trial. We assessed the PSA values, numbers of men biopsied (biopsy indication: PSA level of 3.0 ng/mL or greater), and numbers of cancers detected at the second and third screening visits.
A total of 1327 men (79.3%) attended the second screening visit. Of these men, 13 (0.98%) had a PSA level of 3.0 ng/mL or greater, and three cancers were detected (cancer detection rate 0.23%). At the third screening visit, 1017 men (76.8%) attended, 34 men (3.3%) had a PSA level of 3.0 ng/mL or greater, and five cancers were detected (cancer detection rate 0.49%). The 2344 subsequent PSA determinations in an 8-year period after the initial screening resulted in eight cancers detected, for an overall cancer detection rate of 0.47%. Through linkage of all men with the cancer registry, no additional cancers were found.
A strategy of PSA screening every 8 years for men with a PSA level of 1.0 ng/mL or less will lead to a considerable decrease in the number of screening visits (with the associated costs and stress), with a minimal risk of missing aggressive cancer at a curable stage.

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    • "In an analysis of 1703 men aged 55–65 yr with a PSA level 1.0 ng/ml who underwent two screening rounds in the Rotterdam section of the ERSPC, only 8 PCa cases were diagnosed at 8 yr, resulting in an overall PCa detection rate of 0.47% [30]. These data are similar to findings of other groups that reported a PCa detection rate of 0.08% and 0.9% after follow-up of 4 yr and 7.6 yr, respectively [31] [33]. "
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    ABSTRACT: The recommendations and the updated EAU guidelines consider early detection of PCa with the purpose of reducing PCa-related mortality and the development of advanced or metastatic disease. This paper presents the recommendations of the European Association of Urology (EAU) for early detection of prostate cancer (PCa) in men without evidence of PCa-related symptoms. The working panel conducted a systematic literature review and meta-analysis of prospective and retrospective clinical studies on baseline prostate-specific antigen (PSA) and early detection of PCa and on PCa screening published between 1990 and 2013 using Cochrane Reviews, Embase, and Medline search strategies. The level of evidence and grade of recommendation were analysed according to the principles of evidence-based medicine. The current strategy of the EAU recommends that (1) early detection of PCa reduces PCa-related mortality; (2) early detection of PCa reduces the risk of being diagnosed and developing advanced and metastatic PCa; (3) a baseline serum PSA level should be obtained at 40-45 yr of age; (4) intervals for early detection of PCa should be adapted to the baseline PSA serum concentration; (5) early detection should be offered to men with a life expectancy ≥10 yr; and (6) in the future, multivariable clinical risk-prediction tools need to be integrated into the decision-making process. A baseline serum PSA should be offered to all men 40-45 yr of age to initiate a risk-adapted follow-up approach with the purpose of reducing PCa mortality and the incidence of advanced and metastatic PCa. In the future, the development and application of multivariable risk-prediction tools will be necessary to prevent over diagnosis and over treatment.
    European Urology 07/2013; 64(3). DOI:10.1016/j.eururo.2013.06.051 · 13.94 Impact Factor
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    • "Such information could be used to reassure men and possibly reduce their need for further PSA testing, particularly in individuals with PSA 1.00 ng/ml. Previous studies have suggested that the optimal screening intervals for this group might be 4–8 yr [30] [31] [32]. However, our results imply that these intervals may be prolonged, thereby further reducing the number of PSA tests currently performed. "
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    ABSTRACT: It is largely unknown whether prostate-specific antigen (PSA) level at first date of testing predicts long-term risk of prostate cancer (PCa) incidence and mortality in the general population. Determine whether baseline PSA levels predict long-term risk of PCa incidence and mortality. We examined 4383 men aged 20-94 yr from the Danish general population in the prospective Copenhagen City Heart Study. PSA was measured in plasma samples obtained in 1981-1983. PCa incidence and mortality as a function of baseline PSA was assessed using Kaplan-Meier plots of cumulative incidence and competing risk subhazard ratios. During 28 yr of follow-up, 170 men developed PCa, and 94 men died from PCa. Median follow-up was 18 yr (range: 0.5-28 yr). For PCa incidence, the subhazard ratio was 3.0 (95% confidence interval [CI], 1.9-4.6) for a PSA level of 1.01-2.00 ng/ml, 6.8 (95% CI, 4.2-11) for PSA 2.01-3.00 ng/ml, 6.6 (95% CI, 3.4-13) for PSA 3.01-4.00 ng/ml, 16 (95% CI, 10.4-25) for PSA 4.01-10.00 ng/ml, and 57 (95% CI, 32-104) for PSA >10.00 ng/ml versus 0.01-1.00 ng/ml. For PCa mortality, corresponding subhazard ratios were 2.2 (95% CI, 1.3-3.9), 5.1 (95% CI, 2.8-9.0), 4.2 (95% CI, 1.8-10), 7.0 (95% CI, 3.8-14), and 14 (95% CI, 6.0-32). For men with PSA levels of 0.01-1.00 ng/ml, the absolute 10-yr risk of PCa was 0.6% for ages <45 yr, 0.7% for ages 45-49 yr, 1.1% for ages 50-54 yr, 1.2% for ages 55-59 yr, 1.3% for ages 60-64 yr, 1.1% for ages 65-69 yr, 1.3% for ages 70-74 yr, and 1.5% for ages ≥75 yr; corresponding values for PSA levels >10.00 ng/ml were 35%, 41%, 63%, 71%, 77%, 69%, 75%, and 88%, respectively. Stepwise increases in PSA at first date of testing predicted a 3-57-fold increased risk of PCa, a 2-16-fold increased risk of PCa mortality, and a 35-88% absolute 10-yr risk of PCa in men with PSA levels >10.00 ng/ml. Equally important, the absolute 10-yr risk of PCa in men with PSA levels 0.01-1.00 ng/ml was only 0.6-1.5%.
    European Urology 11/2011; 61(5):865-74. DOI:10.1016/j.eururo.2011.11.007 · 13.94 Impact Factor
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    ABSTRACT: Vroege opsporing van prostaatkanker is controversieel, omdat met de huidige beschikbare tests de kosten, in dit geval de lasten voor de patiënt, nog niet opwegen tegen de baten. Het sleutelwoord is risicostratificatie, hoe kunnen we díe mannen identificeren die echt baat hebben bij vroege opsporing van hun prostaatkanker? Op basis van de serum PSA-test is een eerste risicostratificatie mogelijk, maar het in evenwicht brengen van de lasten en baten vraagt om een multivariate aanpak, waarbij inclusie van informatie over het prostaatvolume cruciaal is. Naast een risicostratificatie is wetenschappelijk betrouwbare informatie over de gevolgen van vroege opsporing van prostaatkanker uitermate belangrijk om gezamenlijk, de (potentiële) patiënt en de behandelend arts, tot een besluit te komen.
    12/2013; 2(8). DOI:10.1007/s13629-012-0103-4
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