Kiemeney L., Broeders M., Vasen H., Kil P., Witjes J.A.

Presented on March, 23 2007

INTRODUCTION & OBJECTIVES: Urologists and GPs are increasingly confronted with requests for early detection of prostate cancer in men from hereditary prostate cancer (HPC) families. Although screening of these men seems logical, little is known about the pros and cons of screening. We studied the effect of screening with PSA in unaffected men from HPC families, aged 50-75 years, on surrogate endpoints (test and tumour characteristics).

MATERIAL & METHODS: The Netherlands Foundation for the Detection of Hereditary Tumours (StOET) holds information on 153 verified HPC families, of which 103 families comprised non-affected family members. Here, 169 men from these families were included and invited to see a GP for PSA testing. Men with a PSA level ≥ 3 ng/ml were referred to a urologist for transrectal prostate biopsies. Data on PSA tests in 71 additional men already under surveillance by a GP or urologist and known to the StOET were included in the analysis. Results were compared with published data from the European Randomized Study of Screening for Prostate Cancer (ERSPC).

RESULTS: We identified an initial PSA test (= ’first screening round’) for 237 men. Mean PSA = 2.3 ng/ml; range 0.04-24.9. Serum PSA was elevated (≥ 3 ng/ml) in 51 men screened (referral rate=22%), among whom 5 were detected (detection rate=2.1%). Compared to the results of the Rotterdam section of the ERSPC, the PSA-distribution and referral rate (ERSPC: 20%) are similar, but the detection rate seems lower (ERSPC: 5.3%). The definition of subsequent screening rounds in our study was severely hampered by the frequent use of opportunistic PSA testing with short screening intervals. In total, at initial and subsequent PSA tests, 19 prostate cancers were detected. 15 of these 19 cancers had favourable tumour characteristics (pT2 or cT1c and Gleason < 7).

CONCLUSIONS: The screening of non-affected members of HPC families does not yield more or more aggressive cancers than  population-based screening. This raises the question whether these men should be considered high-risk. A more aggressive screening policy does not seem justified.

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