Prostate Cancer Screening with PSA: Ten Years’ Experience of Population Based Early Prostate Cancer Detection Programme in Lithuania

Abstract

The aim of this study is to report key performance estimates from the ten years of a population-based prostate cancer screening programme in Lithuania. Retrospective analysis of screening activities recorded in 2006–2015 among men aged 50–74 years was performed. We estimated screening coverage, cancer detection rate, compliance to biopsy, and positive predictive values in each screening round inside and outside the target population. In the first 10 years of screening, 16,061 prostate cancer cases were registered within the screening programme, 10,202 were observed among screened men but reported outside the screening programme, and 1455 prostate cancers were observed in a screening-naïve population. Screening cover reached up to 45.5% of the target population in the recent rounds. The proportion of prostate specific antigen (PSA) test-positive men decreased from 16.9% in 2006 to 10.7% in 2014–2015. Up to 40.0% of PSA test-positive men received a biopsy, of whom 42.0% were positive for prostate cancer. The cancer detection rate was 10.4−15.0% among PSA test-positives and 1.4–1.9% among screened individuals. Screening participants were more likely to be diagnosed with organ-confined disease as compared to non-participants. Despite the unorganized screening practices being employed and low coverage per screening round, 70% of the target population were screened at least once in the first 10 years of screening.

Are sex disparities in COVID-19 a predictable outcome of failing men’s health provision?

“…This contrasts with gynaecological services, which are present in most hospitals and manage female infertility, lower urinary tract symptoms (LUTS), ovarian, endometrial and cervical cancer, and a range of disorders related to menstruation, menopause, family planning, sexual dysfunction and sexually transmitted infections. No male-specific screening programmes are run within the UK and, although prostate cancer screening is practised in some countries 90 , the diagnostic pathways are variable and can comprise only a PSA blood test and prostate biopsies, despite the publication of both the PROMIS 91 and the PRECISION 92 trials that highlighted that non-parametric MRI increases the detection of clinically significant prostate cancer. A European Association of Urology (EAU) white paper on prostate cancer 93 highlighted the main criticisms of prostate cancer screening, which are the overdiagnosis and potential overtreatment of prostate cancer, but this is a health-care provider interpretation and there are no large studies on the patient perspectives of overdiagnosis.…”

All-Cause Mortality Risk in National Prostate Cancer Cohort: An Impact of Population-Based Prostate Cancer Screening

“…More surprisingly, among screened patients with the localized stage of the disease there was an observed lower all-cause mortality risk compared to the general population. The so called “stage migration” was described in our previous studies [ 13 , 26 ] and the biggest proportion in our population-based screening cohort was localized disease. Therefore, we could assume that lower mortality risk in the screened patient population is mainly caused by earlier diagnosis.…”

“…Lithuania has operated the national Early Prostate Cancer Detection Program (EPCDP) since 2006 [ 13 ]. This program works in the setting of nationwide PSA test-based screening and 70% of men aged 50 years to 74 years have participated in the prostate cancer program at least once in the first 10 years of the screening.…”

An analysis of time trends in breast and prostate cancer mortality rates in Lithuania, 1986–2020

“…Previous studies have shown the time lag of 7-9 years between the increasing PSA testing and subsequent reductions in mortality due to beneficial treatment of earlier diagnosed cases [6,7]. More conservative use of PSA testing (less screening outside the target age groups, longer screening interval) may have also contributed to the reduction in misattributed cause of death and decreasing mortality rates [11,42,43]. Despite the implemented organized national screening programme, the favourable tendency in PC mortality in Lithuania was weak compared to European men, with the death rates remaining among the highest in Europe [3,6,7,10,32].…”