Prostate Cancer Screening Must Be Continued To Be Effective

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 28 Jun 2008 - 5:00 PDT

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ORLANDO, FL (UroToday.com) - The AUA and American Cancer Society advocate offering men annual screening with serum PSA and DRE starting at age 50 years in the general population and earlier in high-risk men. In studies to examine whether lung cancer screening is beneficial, an important feature of using CT screening was that the screening regimen must be strictly adhered to in order to detect important changes (New York Early Lung Cancer Action Project). In an analogous fashion, the goal of these investigators was to evaluate the number and characteristics of cancers that would be missed if initial prostate cancer screening were not continued annually.

From 1989 to 2001, 35,456 men were enrolled in a longitudinal prostate cancer screening study, in which they were recommended to return on a semi-annual or annual basis (depending on their screening results) for PSA and DRE. Prostate biopsy was recommended for suspicious DRE or a PSA level >4.0 ng/ml (until 1995) or >2.5 ng/ml (after 1995). 14,602 (41%) men had a suspicious PSA or DRE during at least one of their screening visits, 10,137 (29%) men underwent a biopsy, and 3367 (9%) were diagnosed with prostate cancer. They examined the number and characteristics of cancers detected after varying numbers of regular screening visits, to determine the efficacy of long term screening protocols.

Of the men, 3367 (9%) were diagnosed with prostate cancer throughout the course of the study after 1 to 24 semiannual or annual visits. 2332 (69%) of these cancers were diagnosed after at least 2 screening visits, 1936 (57%) after at least 3, 738 (22%) after at least 10, and 33 (10%) after at least 15. Overall, 520 (15%) of the detected cancers had a biopsy Gleason score >6. Specifically, 341 (66%of Gleason >6 cancers) were diagnosed after at least 2 screening visits, 291 (56%) after at least 3 visits, 144 (28%) after at least 10, and 57 (11%) after at least 15. Of the 3367 men who were diagnosed with prostate cancer, 2193 underwent radical prostatectomy and 1583 (72%) of these men had organ confined disease with clear surgical margins.

Annual prostate cancer screening must be continued to be effective in accomplishing the goal of early diagnosis. More than 50% of prostate cancers diagnosed during the screening study were detected after at least 3 screening visits, and 10% were not diagnosed until after at least 15 visits. Moreover, a considerable proportion of the men diagnosed with prostate cancer after many serial visits had high-grade disease. This suggests that a substantial number of significant prostate cancers would have been missed without continued annual screening.

Presented by Christopher R Griffin, MD, Kimberly a Roehl, MD, Stacy Loeb, MD, Dana M Mondo, MD, Sara N Gashti, MD, William J Catalona, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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