Prostate Testing for Cancer and Treatment (ProtecT) feasibility study

Donovan, Jenny; Hamdy, Freddie C.; Neal, DE; Peters, Tim J.; Oliver, SE; Brindle, LA; Jewell, David; Powell, P. H.; Gillatt, David; Dedman, DJ; Mills, Nicola; Smith, Monica; Noble, Sian; Lane, Athene

doi:10.3310/hta7140

Cited by 212 publications

(102 citation statements)

References 44 publications

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“…For assessment of the local tumor stage, routine diagnostics (i.e., digital rectal examination, serum prostate-specific antigen (PSA) level, transrectal ultrasound, and biopsy Gleason score [3, 8]) are insufficient [9]. When combining these clinical parameters into predictive nomograms (e.g., the Partin Tables), staging accuracy increases, but remains imperfect [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Local staging with multiparametric MRI in daily clinical practice: diagnostic accuracy and evaluation of a radiologic learning curve

et al. 2018

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PurposeTo estimate the diagnostic accuracy of multiparametric MRI (mpMRI) for the detection of locally advanced prostate cancer (T-stage 3–4) prior to radical prostatectomy, in a multicenter cohort representing daily clinical practice. In addition, the radiologic learning curve for the detection of locally advanced disease is evaluated.MethodsPreoperative mpMRI findings of 430 patients (2012–2016) were compared to pathology results following radical prostatectomy. The diagnostic accuracy (sensitivity, specificity, PPV, and NPV) for the detection of locally advanced disease was calculated and compared for all years separately, to evaluate the presence of a radiological learning curve.ResultsOf all 137 patients with locally advanced disease, 62 patients were preoperatively detected with mpMRI [sensitivity 45.3% (95% CI 36.9–53.6%), specificity 75.8% (CI 70.9–80.7%), PPV 46.6% (CI 38.1–55.1%), and NPV 74.7% (CI 69.8–79.7%)]. The diagnostic accuracy did not improve significantly over time (sensitivity p = 0.12; specificity p = 0.57).ConclusionsIn daily clinical practice, the diagnostic accuracy of mpMRI for the detection of locally advanced prostate cancer remains limited. It, therefore, seems questionable whether mpMRI is adequate to guide preoperative decision-making. No significant radiologic learning curve for the detection of locally advance disease was observed.

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Section: Introductionmentioning

confidence: 99%

Local staging with multiparametric MRI in daily clinical practice: diagnostic accuracy and evaluation of a radiologic learning curve

et al. 2018

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“…2 Screening for prostate cancer and the optimum treatment are controversial and three trials of screening are ongoing; the prostate, lung, colorectal and ovarian trial; the European randomised screening for prostate cancer trial; and the comparison arm of the prostate testing for cancer and treatment study (ProtecT). 3 4 Three current trials of treatment are based on screen detected populations: the prostate testing for cancer and treatment study, 5 the prostate cancer intervention versus observation trial, 6 and the surveillance therapy against radical treatment trial. 7 An earlier randomised trial with cases of clinically detected prostate cancer showed a survival benefit of surgery compared with watchful waiting, with a median follow-up of 8.2 years.…”

Section: Introductionmentioning

confidence: 99%

“…17 In the prostate testing for cancer and treatment study, unselected men aged 50-69 have been invited for a prostate specific antigen test at nine UK centres since June 2001 to evaluate the effectiveness, cost effectiveness, and acceptability of treatments for clinically localised prostate cancer preceded by community based testing for prostate specific antigen. 5 Using the same methods we carried out a nested study in men aged 45-49 to investigate the uptake of testing, the prevalence of prostate cancer, and characteristics of the disease.…”

Section: Introductionmentioning

confidence: 99%

Detection of prostate cancer in unselected young men: prospective cohort nested within a randomised controlled trial

Lane

Howson

Donovan

et al. 2007

BMJ

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Objective To investigate the feasibility of testing for prostate cancer and the prevalence and characteristics of the disease in unselected young men. Design Prospective cohort nested within a randomised controlled trial, with two years of follow-up. Setting Eight general practices in a UK city. Participants 1299 unselected men aged 45-49. Intervention Prostate biopsies for participants with a prostate specific antigen level of 1.5 ng/ml or more and the possibility of randomisation to three treatments for those with localised prostate cancer. Main outcome measures Uptake of testing for prostate specific antigen; positive predictive value of prostate specific antigen; and prevalence of prostate cancer, TNM disease stage, and histological grade (Gleason score). Results 442 of 1299 men agreed to be tested for prostate specific antigen (34%) and 54 (12%) had a raised level. The positive predictive value for prostate specific antigen was 21.3%. Ten cases of prostate cancer were detected (2.3%) with eight having at least two positive results in biopsy cores and three showing perineural invasion. One tumour was of high volume (cT2c), Gleason score 7, with a positive result on digital rectal examination; nine tumours were cT1c, Gleason score 6, and eight had a negative result on digital rectal examination. Five of the nine eligible participants (55%) agreed to be randomised. No biochemical disease progression in the form of a rising prostate specific antigen level occurred in two years of follow-up. Conclusions Men younger than 50 will accept testing for prostate cancer but at a much lower rate than older men. Using an age based threshold of 1.5 ng/ml, the prevalence of prostate cancer was similar to that in older men (3.0 ng/ml threshold) and some cancers of potential clinical significance were found. Trial registration Current Controlled Trials ISRCTN20141297

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“…Typically, these assessments start by describing a hypothetical trial including information about randomization, the research question motivating the trial, previous research, and the potential risks and benefits of both treatment arms 39,[44][45][46] . The description is then followed by an interview or survey to measure patient preferences and decision-making strategies as they pertain to trial participation.…”

Section: Presentations and Surveymentioning

confidence: 99%

Preference Assessment of Recruitment into a Randomized Trial for Adolescent Idiopathic Scoliosis

Dolan

Sabesan

Weinstein

et al. 2008

The Journal of Bone and Joint Surgery-American Volume

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Prostate Testing for Cancer and Treatment (ProtecT) feasibility study

Cited by 212 publications

References 44 publications

Local staging with multiparametric MRI in daily clinical practice: diagnostic accuracy and evaluation of a radiologic learning curve

Local staging with multiparametric MRI in daily clinical practice: diagnostic accuracy and evaluation of a radiologic learning curve

Detection of prostate cancer in unselected young men: prospective cohort nested within a randomised controlled trial

Preference Assessment of Recruitment into a Randomized Trial for Adolescent Idiopathic Scoliosis

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