Incidence of Prostate Cancer in Sicily: Results of a Multicenter Case-Findings Protocol

Prostate Cancer Prostatic Dis

Aragona

2010

To evaluate prostate cancer (PCa) detection and incidence of pathologically insignificant PCa (pIPCa) tumour using percent-free PSA (%f-PSA) in patients with total PSA p10 ng ml À1 . From February 2002 to October 2009, 14 453 patients (median 60.5 years) were enrolled in a case-finding protocol for the early diagnosis of PCa. Indications to biopsy were suspicious digital rectal examination; PSA 410 ng ml À1 ; PSAp2.5 ng ml À1 , included between 2.6-4 and 4.1-10 ng ml À1 with %f-PSA o15, o20 and o25%, respectively. A median of 18 and 26 cores in case of primary and repeated biopsy were determined; 2123 men underwent prostate biopsy, of whom 1589 (74.8%) had a PSA p10 ng ml À1 . A PCa was found in 777 (36.6%) and in 35 (23.3%) patients at primary and repeated biopsy: 459 and 26 men had PSA p10 ng ml À1 and 419 and 26 patients underwent surgery, respectively, 244 (58.3%) and 18 (69.2%) had an organ-confined PCa with a pIPCa incidence equal to 1.4 and 7.7%, respectively. Cancer detection rate of 28.8% in patients with PSA p10 ng ml À1 associated with a low incidence of pIPCa should induce to introduce %f-PSA in screening programmes to reduce the risk of overdiagnosis.

Section: Discussionsupporting

confidence: 43%

Section: Discussionsupporting

confidence: 43%

Section: Methodsmentioning

confidence: 99%

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Incidence of insignificant prostate cancer using free/total PSA: results of a case-finding protocol on 14 453 patients

Prostate Cancer Prostatic Dis

Aragona

2010

“…The patients were enroled in a case-finding protocol for PCa 4 and indications for TURP were PSA410 ng ml À1 ; PSA included between 4.1 and 10 or 2.6 and 4 ng ml À1 with free/total PSA p25 and p20%, respectively. 4 All men had previously underwent a second negative SPBx following the same clinical indications (patients with high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation did not meet inclusion criteria); a median of 28 (range: 26-38) cores were taken in the posterior zone including 3.5 (median; range: 3-5) cores in the transitional and anterior zones. The median PSA was 11.8 ng ml À1 (range: 2.7-36) and only 58 (77.4%) patients had abnormal International Prostate Symptom Score (IPSS).…”

Section: From June 2005 To February 2008 75 Consecutivementioning

confidence: 99%

Prostate cancer detection by TURP after repeated negative saturation biopsy in patients with persistent suspicion of cancer: a case–control study on 75 consecutive patients

Prostate Cancer Prostatic Dis

Fraggetta

Galia

et al. 2009

To evaluate prostate cancer (PCa) detection after repeated negative saturation biopsy, 75 patients, aged 53-78 years, underwent transurethral resection of prostate (TURP) because of persistent suspicion of cancer; median PSA was 11.8 ng ml À1 and 58 men complained lower urinary tract symptoms (LUTS). In 12 (16%) and 3 (4%) men a T1a and T1b PCa was found with median PSA and Gleason score equal to 14.2 vs 23.6 ng ml À1 and 5.6 vs 7 ng ml À1 . In case of persistent suspicion of PCa after repeated negative saturation biopsy, TURP may be proposed, aside from the coexistence of LUTS, to rule out a PCa, in younger patients with high PSA values (X20 ng ml À1 ).

“…In our experience (16,298 subjects, aged 40–75, who entered a multicenter case-finding protocol for early diagnosis of PCa), the overall incidence of PCa in men with PSA ≤4 ng/ml was less than 1%; using a %-fPSA cutoff as selection criterion for biopsy, a PCa was found in 25.6% of men with PSA ≤2.5 and %-fPSA ≤15% and in 27.4% of men whose total PSA ranged between 2.6 and 4 ng/ml with %-fPSA ≤20% [94]. Such a high prevalence of cancer in patients belonging to the lowest PSA levels demonstrates that the indications for biopsy according to %-fPSA were appropriate in most cases.…”

Section: Is Serum Psa Predictive Of a Future Diagnosis Of Pca?mentioning

confidence: 99%

Should Men with Serum Prostate-Specific Antigen ≤4 ng/ml and Normal Digital Rectal Examination Undergo a Prostate Biopsy?

Panella²,

D’Arrigo³

et al. 2006

Oncology

The clinical significance of a prostate cancer (PCa) cannot be determined solely by tumor volume (≤0.5 cm³), as small tumors of higher Gleason grade and tumors occurring in younger men may become clinically significant even though the initial volume at diagnosis is small. A certain number of these minimal cancers are likely to remain clinically insignificant; however, it is unpredictable how many can progress beyond the curable stage by the time there is a rise in serum prostate-specific antigen (PSA) values. Compared to clinically detected PCa, PCa detected exclusively by PSA screening (clinical stage T1c) are less likely to be advanced but no more likely to be insignificant in terms of volume, pathologic stage, and Gleason pattern. Only 10–15% of PSA-detected cancers have the features of PCa found at autopsy or in cystoprostatectomy specimens. Actually, 25–30% of PCa are detected with PSA values between 2.5 and 4 ng/ml, and most of these cancers are clinically significant. Evidence from both retrospective and longitudinal studies has shown that the risk of a PCa is dependent on the patient’s age and the initial serum PSA. This allows an individualized approach to PCa screening programs, and PSA cutoff values for biopsy indication may be lowered in selected patients.