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