Is further screening of men with baseline PSA < 1 ng ml⁻¹worthwhile? The discussion continues-Results of the Swiss ERSPC (Aarau)

Abstract

Recent studies indicate frequent early PSA retesting unrelated of men's baseline PSA, which increases the harms of early detection especially among men with low PSA. The current study investigates the PCa incidence among men with baseline PSA <1.0 ng ml 21 in order to adjust retest intervals for more targeted early detection. Between 1998 and 2012, 2,416 men with baseline PSA <1.0 ng ml 21 were prospectively observed. Primary endpoint was PCa diagnosis. Negative predictive value (NPV) and number needed to screen (NNS) to detect one PCa were calculated. During a median follow-up time of 12.1 years, 54 (2.2%) PCa were diagnosed with n 5 26 (48.1%) among men with baseline PSA of 0.75 1.0 ng ml 21 (upper baseline PSA quartile). The 10-year probability of being diagnosed with PCa increased significantly from 0.19% (baseline PSA < 0.40 ng ml 21 ) to 2.0% (baseline PSA 0.40 0.56 ng ml 21 ), 2.5% (baseline PSA 0.56 0.75 ng ml 21 ) over 4.4% (baseline PSA 0.75 1.0 ng ml 21 ) (all p values <0.0001), respectively. The frequency of Gleason 7 PCa increased from 1 (0.17%) to 8 (1.4%), 5 (0.8) over 11 (1.8%) in these groups. The 8-year NPV for Gleason 7 PCa were 99.8 (baseline PSA < 0.40 ng ml 21 ), 99.8 (baseline PSA 0.40 0.56 ng ml 21 ), 100 (baseline PSA 0.56 0.75 ng ml 21 ) and 99.5 (baseline PSA 0.75 1.0 ng ml 21 ), respectively. During 12 years, the numbers were 99.8, 98.6, 99.2, and 98.2, respectively. Therefore, due to the very low rate of Gleason 7 PCa, further screening might be omitted in men with baseline PSA < 0.4 ng ml 21 . Between 0.4 and 1.0 ng ml 21 , an 8-year interval can be discussed.

A positive family history as a risk factor for prostate cancer in a population‐based study with organised prostate‐specific antigen screening: results of the Swiss European Randomised Study of Screening for Prostate Cancer (ERSPC, Aarau)

“…Consequently, in population‐based screening studies, most detected prostate cancers have low‐risk features , most of which harbour a negligible risk to metastasise . Ideally, these low‐risk prostate cancers should remain undetected, which indicates the need of risk‐stratified screening .…”

Screening for prostate cancer: History, evidence, controversies and future perspectives toward individualized screening

“…This advanced model might be more useful in developed countries, where the incidence of insignificant prostate cancer, especially in geriatric populations, has been increasing. The optimal screening interval based on the baseline PSA concentration has not been clarified, but the use of a baseline PSA‐adjusted screening interval could be theoretically reasonable compared with the use of a fixed screening interval …”

“…The optimal screening interval based on the baseline PSA concentration has not been clarified, but the use of a baseline PSA-adjusted screening interval could be theoretically reasonable compared with the use of a fixed screening interval. 65,67,85,[106][107][108][109][110][111][112] The future perspectives on prostate cancer management, including screening, and diagnostic and treatment systems for prostate cancer, might not only be aimed at decreasing the mortality of prostate cancer, but also aimed at achieving a significant increase in QALY with acceptable ICER. Countermeasures against overdetection according to widely available biomarkers, including proenzyme PSA 113 and magnetic resonance imaging-targeted biopsy, 114 and those against overtreatment by appropriate introduction of an active surveillance strategy, should be considered concomitantly with the establishment of an individualized screening system based on the baseline PSA concentration at a certain age.…”

Evidenced‐based clinical practice guideline for prostate cancer (summary: Japanese Urological Association, 2016 edition)

“…It is also important to stratify the risk for morbidity and mortality according to baseline PSA levels. We therefore recommend that individuals undergo PSA screening every 3 years if their baseline level is ≤1.0 ng/mL, or every year if their PSA level is between 1.1 ng/mL and the cut‐off level …”

“…We therefore recommend that individuals undergo PSA screening every 3 years if their baseline level is ≤1.0 ng/mL, or every year if their PSA level is between 1.1 ng/mL and the cut-off level. [26][27][28] The most important benefit of PSA screening has been shown to be a decrease in the mortality rate. However, overdiagnosis, overtreatment and decreased QOL from the treatment are all potential drawbacks of screening.…”