Predictors for biopsy outcome in the European Randomized Study of Screening for Prostate Cancer (Rotterdam Region)

Abstract

BACKGROUND In the European Randomized Study of Screening for Prostate Cancer (ERSPC, Rotterdam region), men aged 55–74 years are screened for prostate cancer by prostate‐specific antigen (PSA) sampling, digital rectal examination (DRE), and transrectal ultrasound investigation (TRUS). All men with a PSA ≥4 ng/ml and/or a suspicious DRE and/or a suspicious TRUS are biopsied. METHODS Logistic regression analysis was applied to derive a predictive index that equals the chance to find prostate cancer in a biopsy given the outcomes of the screening tests. This model was used to assess the number of cancers that could have been detected if all men had been biopsied (extrapolation). Furthermore, the model was used to study the possibilities for improvement of the current screening protocol. RESULTS PSA was the dominant predictor for prostate cancer in a biopsy, followed by prostate volume, DRE, and TRUS result. It is assessed that 69% (95% CI, 52–86%) of cancers that could be identified if all men were biopsied are currently detected. Application of the same methods to screening data obtained in Göteborg (the Swedish ERSPC partner) yielded almost identical results. It was found that, in the Rotterdam protocol, a considerable number of men were biopsied according to the screening protocol with an assessed lower chance to have prostate cancer than men who were not biopsied according to the protocol. CONCLUSIONS The chance to detect prostate cancer in a biopsy can be modeled quite accurately as a function of serum PSA, prostate volume, DRE, and TRUS results. Important improvements in the screening protocol can be achieved by the application of the predictive index. Prostate 39:316–322, 1999. © 1999 Wiley‐Liss, Inc.

Stronger Association between Obesity and Biochemical Progression after Radical Prostatectomy among Men Treated in the Last 10 Years

“…Another possible detection bias results from the fact that multiple studies, including the current, found that obese men have larger prostates (23,24,27). Prostatic enlargement would make detection of an existent cancer less likely, given an equal-sized tumor and an equal number of biopsy cores were obtained (32,33). Combining lower PSA concentrations and prostatic enlargement would represent an inherent bias against detecting cancers among obese men.…”

Algorithms based on prostate‐specific antigen (PSA), free PSA, digital rectal examination and prostate volume reduce false‐postitive PSA results in prostate cancer screening

“…DISCUSSION Earlier studies showed that algorithms based on total PSA, free PSA, DRE and prostate volume can be used to reduce the number of false-positive PSA results in screening for prostate cancer more efficiently than the proportion of free PSA alone. [12][13][14][15][16][17][18][19] Despite this, there are no reports on the use of such algorithms in a prospective setting. Our study included 1,775 screen-positive men from the 3 largest participating centers in the European Randomized Study of Screening for Prostate Cancer, 20 -22 making it the largest study on predicting prostate biopsy results in the PSA range 4 -10 g/l using LR and neural networks.…”

“…Combined use of several variables has been shown to reduce the number of false-positive PSA results more efficiently than single use of the proportion of free PSA. [12][13][14][15][16][17][18][19] However, LR or neural network algorithms for prostate cancer detection have not been studied prospectively; i.e., use of algorithm outcomes for making real-life biopsy decisions has not been reported. We simulated a prospective setting by using earlier subjects as training data and later ones for testing of the algorithms.…”

Is screening for prostate cancer with prostate specific antigen an appropriate public health measure?

“…However, up to two-thirds of cancers were missed at the 4 ng/ml threshold. In a community-based study of serial screening, 22% of men older than 50 years with PSA concentrations between 2.6 and 4.0 ng/ml had prostate cancer [27]. In the European Randomized Study of Screening for Prostate Cancer (ERSPC), 36.5% of detectable prostate cancers were identified in the 87.5% of men who had PSA concentrations lower than 4 ng/ml.…”