Adult urologyIs 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)
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
References (16)
- et al.
The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial of the National Cancer Institutehistory, organization, and status
Control Clin Trials
(2000) - et al.
Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial
Control Clin Trials
(2000) - et al.
Prostate specific antigen based biennial screening is sufficient to detect almost all prostate cancers while still curable
J Urol
(2003) - et al.
Prostate cancer mortality after introduction of prostate-specific antigen mass screening in the Federal State of Tyrol, Austria
Urology
(2001) - et al.
Natural history of PSA increase with and without prostate cancer
Urology
(2003) - et al.
Prostate-specific antigen-based early detection of prostate cancer—validation of screening without rectal examination
Urology
(2001) - et al.
Prostate-specific antigen variability in men without prostate cancereffect of sampling interval on prostate-specific antigen velocity
Urology
(1995) - et al.
The story of the European Randomized Study of Screening for Prostate Cancer
BJU Int
(2003)