Adherence to a risk‐adapted screening strategy for prostate cancer: First results of the PROBASE trial

Abstract

PROBASE is a population‐based, randomized trial of 46 495 German men recruited at age 45 to compare effects of risk‐adapted prostate cancer (PCa) screening starting either immediately at age 45, or at a deferred age of 50 years. Based on prostate‐specific antigen (PSA) levels, men are classified into risk groups with different screening intervals: low‐risk (<1.5 ng/ml, 5‐yearly screening), intermediate‐risk (1.5‐2.99 ng/ml, 2 yearly), and high risk (>3 ng/ml, recommendation for immediate biopsy). Over the first 6 years of study participation, attendance rates to scheduled screening visits varied from 70.5% to 79.4%, depending on the study arm and risk group allocation, in addition 11.2% to 25.4% of men reported self‐initiated PSA tests outside the PROBASE protocol. 38.5% of participants had a history of digital rectal examination or PSA testing prior to recruitment to PROBASE, frequently associated with family history of PCa. These men showed higher rates (33% to 57%, depending on subgroups) of self‐initiated PSA testing in‐between PROBASE screening rounds. In the high‐risk groups (both arms), the biopsy acceptance rate was 64% overall, but was higher among men with screening PSA ≥4 ng/ml (>71%) and with PIRADS ≥3 findings upon multiparameter magnetic resonance imaging (mpMRI) (>72%), compared with men with PSA ≥3 to 4 ng/ml (57%) or PIRADS score ≤ 2 (59%). Overall, PROBASE shows good acceptance of a risk‐adapted PCa screening strategy in Germany. Implementation of such a strategy should be accompanied by a well‐structured communication, to explain not only the benefits but also the harms of PSA screening.

Magnetic Resonance Imaging in Prostate Cancer Screening

“…35,36 According to the data presented in this article, patients are more willing to undergo biopsy when the indication is underlined with MRI results, which is an important factor in achieving better outcomes and a more equal distribution of health care resources. 5,[37][38][39] In modeling studies, MRI-based PCa screening is associated with an improvement in the benefit-harm profile, quality of life, costeffectiveness, and environmental effect of screening for PCa compared with standard PSA-based screening. [40][41][42][43][44] Accordingly, our results synthesizing high-quality prospective data suggested that MRI is effective at identifying individuals who are most likely to require further evaluation and biopsy, potentially reducing the burden on health care resources and sparing patients from having to undergo unnecessary invasive procedures.…”

“…Moreover, avoiding biopsy and following up with patients with negative MRI results were shown to be a safe approach in screening . According to the data presented in this article, patients are more willing to undergo biopsy when the indication is underlined with MRI results, which is an important factor in achieving better outcomes and a more equal distribution of health care resources . In modeling studies, MRI-based PCa screening is associated with an improvement in the benefit-harm profile, quality of life, cost-effectiveness, and environmental effect of screening for PCa compared with standard PSA-based screening .…”

Regional disparities of prostate cancer mortality in Ecuador: an examination of trends and correlates from 2004 to 2019

“…However, some studies have concluded that prostate cancer screening does not improve mortality [ 37 ]. Therefore, some studies recommend optimizing screening criteria to target high-risk populations, as well as increasing awareness and education on the risks and benefits of prostate cancer screening to make informed decisions [ 38 , 39 ].…”

Screening for prostate cancer: evidence, ongoing trials, policies and knowledge gaps

“…Attendance to scheduled screening visits over the first 6 years varied from 70% to 79% across risk groups. 95 Other ongoing prostate cancer screening studies Many non-randomised, prospective prostate cancer screening studies are ongoing. Several evaluate screening of high-risk populations: The UK BARCODE-1 investigates a polygenic risk score for targeting a high-risk population.…”