EAU 2011 - Combining screening and chemoprevention of prostate cancer - Session Highlights

VIENNA, AUSTRIA (UroToday.com) - These investigators combined PSA based screening which has been shown to reduce prostate cancer (CaP) mortality (but identify more Gleason score 6 tumors) and chemoprevention with dutasteride, which reduced CaP detection 22.8% after 4 years in men with a previous negative biopsy (PNBx, due to finding fewer GS 6 tumors).

They hypothesized that a combination of these 2 approaches might reduce side effects of a screening program (unnecessary biopsies, detection of indolent CaP). The goal was to define a PSA based biopsy indication with a high specificity for detecting aggressive CaP in men using a dual 5-ARI. They simulated an individualized re-biopsy strategy for men with a PNBx assuming that they started to use dutasteride. Detailed information from the REDUCE trial on median PSA decrease in dutasteride users over the 4 yr study period per PSA range (2.5-10.0 per 1.0 ng/ml steps) and per biopsy result after 4 yrs (no CaP, CaP with either GS <7, GS = 7 or GS >7) was used. Data were applied to PSA data of men in ERSPC Rotterdam with one PNBx at 1st or 2nd screening and a repeat biopsy 4 yrs later (PSA ≥3.0). The number of biopsies and number CaP detected for these ERSPC men was modeled under the assumption that they start using dutasteride after the first PNBx and were biopsied 4 yrs later only if their calculated PSA level (using REDUCE data on PSA decrease) exceeded 50%, 45% or 40% of their initial PSA.

A total of 1,331 ERSPC participants (PSA 2.5-10.0 ng/ml) were re-biopsied 4 yrs after PNBx, a PPV of 12.6% resulted with 85.1% of the CaP having a GS of 6. After applying the 50% scenario only 22 men would have qualified for biopsy (PPV 100%), saving 1,309 biopsies. No GS 6 PC, all 17 GS 7 CaP and 5 of the 8 GS > 7 CaP would have been detected. Results for the scenarios 45% are: PPV 100% and all CaP with GS ≥7 detected and scenario 40%: PPV 57.7%, all CaP detected. They concluded that this combined approach might decrease unwanted side effects of purely PSA based screening setting.


Presented by Monique J. Roobol, MSc, PhD, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria


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