ASCO GU 2008 - Death From Prostate Cancer In A Screened Population: Relation To PSA Levels At First Screen In The ERSPC Section Rotterdam

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 24 Feb 2008 - 0:00 PDT

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UroToday.com - Within the ERSPC, men with a PSA <3.0ng/ml are not biopsied. This study made comparison of biopsy and cancer detection rates and assessed the chance of dying from CaP in men not biopsied with a PSA <3 ng/ml. They assessed how many biopsies it would take to diagnose and prevent CaP.

19,970 men were screen from 1993-1999, and 80% had a PSA < 3 ng/ml. These 80% were re-screened at 4 and 8 years later. The data was compared to the PCPT trial, where all men were biopsied. In the ERSPC trial, biopsy was done if the PSA was >3.0ng/ml. A total of 3,511 men were biopsied (22%) and 700 cases of CaP were detected. 620 CaP were screen-detected and 80 were interval detected cases. 121 had a Gleason score > 7, (17%) and 53 were potentially non-curable. 8 men have died of disease at 12 years and 7 were interval detected cancers. In the non-curable CaP cases, most had high PSA levels at the followup interval. In those who died of CaP, the PSA at detection was less than 3ng/ml at first screening and rose significantly at the interval detection.

If the PCPT regimen was applied to their study, the detection number would have been 3,472 rather than 700 cases. Calculations show that 299 prostate biopsies would have been necessary to prevent the detection of one non-curable CaP. 1,981 prostate biopsies would have been necessary to prevent one CaP death. Thus, in a setting with repeat screenings, men with low PSA values should not be biopsied. The PSA range 2.0-2.9 should primarily be targeted.

Presented by M. J. Roobol at the American Society of Clinical Oncology (ASCO) - 2008 Genitourinary Cancers Symposium - A Multidisciplinary Approach - February 14-16, 2008 San Francisco, California, USA

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS Professor & Chairman Department of Urology University of California, Davis, School of Medicine Sacramento, CA

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