EAU 2011 - Prostate cancer incidence and disease-specific survival in men participating in the ERSPC with an initial PSA under 3.0 ng/ml - Session Highlights

VIENNA, AUSTRIA (UroToday.com) - The ERSPC (European Randomized Study of Screening for Prostate Cancer) uses a prostate-specific antigen (PSA) cut-off ≥3.0 ng/ml as an indication for prostate biopsy.

The study objective was to analyze the incidence and disease-specific mortality for prostate cancer (CaP) within the ERSPC Rotterdam for men with an initial PSA <3.0 ng/ml over a 15-year follow-up period. From 1993 - 1999, a total of 42,376 men (ages 55-74) were identified from population registries in the Rotterdam region and randomized to a screening or control arm. During the first screening round, 19,950 men were screened, with biopsies being initially recommended for abnormal DRE or PSA ≥4.0 ng/ml. From 1997 on, a PSA cutpoint ≥3.0 ng/ml was used. The screening interval was 4 yrs. A total of 15,758 men (79%) had an initial PSA <3.0 ng/ml. Follow-up was complete until January 2009.

From 1993 – 2008, 915 CaP cases were diagnosed among 15,758 men (5.8%, median age 62.3 yrs) with an initial PSA <3.0 ng/ml. Of these, 733 were screen-detected and 182 interval-detected). Median follow-up was 11 yrs. CaP incidence increased significantly with higher initial PSA levels. Aggressive CaP (clinical stage ≥T2c, Gleason-score ≥8, PSA >20 ng/ml, positive lymph nodes or metastases at diagnosis) was detected in 65/733 screen detected CaP (8.9%) and 102/182 interval detected CaP (56.0%). CaP death occurred in 23 cases (5 screen detected and 18 interval detected) in the total population (0.15%), with increasing risk in men with higher initial PSA values. The risk of aggressive CaP and CaP mortality in a screened population with initial PSA <3.0 ng/ml increased significantly with higher PSA levels. The risk of dying of CaP was small in men with initial PSA <1.0 ng/ml. Interval detected CaP was more aggressive and had a substantial influence on CaP specific mortality.

 

 

Presented by Meelan Bul, MD, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria


 

The opinions expressed in this article are those of the UroToday.com Contributing Medical Editor and do not necessarily reflect the viewpoints of the European Association of Urology (EAU)


 



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