Defining Increased Future Risk For Prostate Cancer: Evidence From A Population Based Screening Cohort

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 12 Jan 2009 - 1:00 PDT

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UroToday.com - For men with a relatively low PSA on prostate cancer (CaP) screening, what is their risk on future screening exams of having CaP detected? This question was addressed by Dr. Fritz Schröder and collaborators in the online edition of the Journal of Urology.

Their work used the Rotterdam Section of the European Randomized Study of Screening for Prostate Cancer (ERSPC) database. Beginning in 1993, men ages 55 to 74 years old underwent screening by PSA, DRE and TRUS. Initially a PSA of >4.0ng/ml prompted a biopsy, but in 1997 this was decreased to >3.0ng/ml. Also, an abnormal DRE or TRUS resulted in the recommendation for a prostate biopsy. Men who did not meet the criteria for a prostate biopsy on the first round of screening, and also had a second screening, comprised the database for this study. To establish the 4-year risk of CaP diagnosis, the number of men in whom CaP was detected at the second screening was divided by the total number of men who completed round 2 of screening. The investigators evaluated 2 populations; population 1 consisted of all men regardless of previous biopsy status (5,176 men) and population 2 excluded the influence of a previous biopsy on the characteristics of PSA as a predictor of CaP, and thus excluded all men who had undergone a biopsy at the first round of screening (3,501 men).

At the first screening, the mean PSA was 2.4ng/ml, and 31.5% met the criteria for prostate biopsy. In population 1, 299 prostate cancer cases were detected among 1,748 biopsies in 5,176 men, reflecting a 5.8% 4-year risk. In population 2, 178 cases of CaP were detected from 760 biopsies in 3,501 men for a 5.1% 4-year risk. This was associated with a mean population PSA of 1.5ng/ml at the first screening. Most cases in the first and second round screening had a Gleason score <7. Men with a PSA value of 1.5ng/ml or greater at round 1 were at significantly greater risk of having a positive biopsy at round 2 compared with men whose initial PSA was <1.5ng/ml.

The authors reported an absolute risk of having a positive biopsy of 3.74/1,000 patient-years for men whose initial PSA was <1.5ng/ml compared to 22.12/1,000 patient-years for men whose initial PSA was >1.5ng/ml. Furthermore, a previous negative biopsy was also associated with a significant reduction in risk for CaP.

Schröder FH, Roobol MJ, Andriole GL, Fleshner N
J Urol. 2008 Nov 12. Epub ahead of print
doi:10.1016/j.juro.2008.09.012

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

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