Presentation Authors: Monique J. Roobol*, Sebastiaan Remmers, Rotterdam, Netherlands, Jonas Hugosson, Goteborg, Sweden, Sigrid Carlsson, New York, NY, Anssi Auvinen, Teuvo Tammela, Tampere, Finland, Louis Denis, Vera Nelen, Antwerp, Belgium, Arnauld Villers, Lille, France, Xavier Rebillard, Montpellier, France, Maciej Kwiatkowski, Franz Recker, Aarau, Switzerland, Marco Zappa, Donella Puliti, Florence, Italy, Alvaro Paez, Marcos Lujan, Madrid, Spain, Christiaan Bangma, Rotterdam, Netherlands
Introduction: To avoid overdiagnosis and to optimize detection of clinically significant prostate cancer (csPCa, defined as Gleason >= 7), a risk-adapted detection strategy with follow-up intervals of two to eight years depending on initial PSA level and age is recommended (figure). Our aim was to review these recommendations using the long-term PCa detection and mortality rates of the well-known ERSPC cohort, applying a predominantly 4-year screening interval.
Methods: We retrospectively assessed (cs)PCa incidence and (disease specific) mortality of 58,771 men (aged 50-70) who, at least, attended one screening visit within ERSPC. Biopsy indication was a PSA >= 3.0 ng/ml. Results are depicted by PSA level and age group at time of first screening.
Results: Median follow-up was 13.5 yr. In men aged 50-59 and a PSA < 1.0 ng/ml at time of 1st screening 45.3% of PCa detected is csPCa. For men with an initial PSA of 3.0 ng/ml this percentage is 24.2%. Similar data for men aged 60-70 yr are 46% and 27.6%, i.e. with rising baseline PSA value the percentage of csPCa decreases pointing towards overdiagnosis due to more intensive screening (repeatedly using a purely PSA driven biopsy protocol). The time from initial screening to detection, ranging from 1.6 to 13.6 yr (caused by screening interval and a purely PSA based biopsy indication) is inversely proportional to the time from diagnosis to death. The percentage of PCa deaths among those PCa patients who died is in the range of 20 to 25 % (except one outlier in age 60-69 yr with baseline PSA < 1.0 yr) indicating that a) despite immediate and repeated screening about a quarter of PCa patients die from their disease and b) potential under treatment in men diagnosed at an elderly age . The chance of dying from PCa in men with low baseline values is however very rare.
Conclusions: Longer screening intervals together with a purely PSA driven biopsy algorithm will always result in men with potentially deadly disease slipping through the net. This is confirmed in other long term PCa screening data. However, more intense PSA based screening results in overdiagnosis. Considering the low number of events in men with low baseline PSA values the current recommendations seem to be in place. Selective detection of aggressive PCa, also at an elderly age and at the same time avoiding overdiagnosis should remain the ultimate goal in PCa early detection.
Source of Funding: International coordination of ERSPC:European Union Grants SOC 95 35109, SOC 96 201869 05F022, SOC 97 201329, SOC 98 32241, the 6th Framework Program of the EU: PMark: LSHC-CT-2004-503011; Unconditional grants: Beckman-Coulter-Hybritech Inc and the European Association of Urology