Elsevier

Urology

Volume 65, Issue 2, February 2005, Pages 343-346
Urology

Adult urology
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)

https://doi.org/10.1016/j.urology.2004.09.046Get rights and content

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Section snippets

Material and methods

The total screening cohort of ERSPC (section Rotterdam) consisted of 21,210 men (aged 55 to 74 years), of whom 19,970 men were actually screened. Of these men, 8036 (40.2%) presented with a PSA value of 0.1 to 1.0 ng/mL. The study population consisted of all men (n = 1703) aged 55 to 65 years with a PSA level of 1.0 ng/mL or less who were screened between October 1991 and March 1996 (initial screening visit). This period and age selection was made to get a cohort of eligible men for two

Results

The 1703 screened men had a mean PSA level of 0.63 ng/mL at the initial screening. The mean PSA value at the second screening visit was 0.87 ng/mL (range 0.1 to 6.2 ng/mL) and was 1.09 ng/mL (range 0.1 to 11.0 ng/mL) at the third screening visit. Table I shows the PSA distribution of men at initial screening and the number and PSA distribution of men attending the second and third screening. Of the eligible 1703 men, 1327 (79%) attended the second screening visit. Loss was owing to death

Comment

The determination of an optimal rescreening interval in a population-based screening setting is important for many reasons. Shorter intervals are preferable to avoid the risk of missing prostate cancers that might be of influence to the main endpoint, decreasing prostate cancer-specific mortality. Longer screening intervals, however, are preferable to avoid overdiagnosis, which is substantial in prostate cancer screening,10 and to reduce costs. The latter will be a key factor in decision making

Conclusions

The numbers of cancers detected after 8 years of follow-up with two subsequent screening visits were very low in men with a PSA level of 1.0 ng/mL or less, which represented 42% of men screened in the age range of 55 to 65 years in our study. In a population-based screening setting, a tradeoff is always present between the specificity (ie, unnecessary screening) and sensitivity (ie, number of cancers detected). A strategy of PSA screening every 8 years for men with a PSA level of 1.0 ng/mL or

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