Roobol M.J.¹, Hugosson J.², Schröder F.H.¹

Presented on March, 22 2007

INTRODUCTION & OBJECTIVES: The European Randomized study of Screening for Prostate Cancer (ERSPC) was initiated to analyze a possible effect of PSA-based screening on prostate cancer mortality. Variations in the screening algorithm, including the interval between different screening rounds, may influence the outcome and it is important that the screening program is sensitive enough to diagnose potentially lethal cancers early enough.
The rate and seriousness of interval cancers (IC) gives an indication on the sensitivity of the screening program and thus of the appropriateness of the length of the screening interval.

MATERIAL & METHODS: The ERSPC comprise 8 centers in Europe and has randomized 268,000 men to either be invited for PSA based screening or act as controls. Within ERSPC different screening intervals are used. In this study we compared the number and characteristics of interval cancers in the Swedish (2-year screening interval) and the Dutch center of ERSPC (4-year screening interval).
In this analysis men aged between 55 and 65 years at the time of their first screening visit were included. All PC cases diagnosed up to December 31, 2005 were assessed by linkage with the national cancer registry.
IC was defined as those cancers that surfaced clinically within a screening interval.
Serious IC was defined as an IC which at diagnosis had at least one of the following characteristics; M1 or N1 or PSA > 20.0 ng/ml or a Gleason score of > 7.
A possible difference between the two centers in the rate of all PC, of IC and of serious IC was tested by Mantel Cox regression analysis.

RESULTS: In Rotterdam a total of 1062 PC cases were detected in 13,301 men screened (2 and partially 3 screening visits performed). In Gothenburg 555 PC cases were detected in 4202 men screened (5 and partially 6 screening visits performed)
During the follow-up time 60 IC surfaced clinically in Rotterdam (of which 13 were serious IC). The corresponding numbers in Gothenburg were 31 and 4 respectively.
The 10-year cumulative incidence of PC in Rotterdam vs. Gothenburg was 8.4% vs. 13.1% (p< 0.001), the cumulative incidence of IC was 0.4% vs. 0.7% (p=0.002), the cumulative incidence of serious IC was 0.1 vs. 0.1 (p=0.559).

CONCLUSIONS: The rate of IC is very low in prostate cancer screening. Most IC are of low grade and stage and probably depend on opportunistic screening even among men enrolled in a screening program. Serious IC are very rare and there does not seem to be any major difference between a two and a four year screening interval.

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