Screening for prostate cancer without digital rectal examination and transrectal ultrasound: Results after four years in the European Randomized Study of Screening for Prostate Cancer (ERSPC), Rotterdam

Abstract

BACKGROUND Omission of DRE/TRUS as biopsy indication results in fewer unnecessary biopsies, but may increase the risk of missing potentially aggressive prostate cancers (PCs). In 1997, the biopsy indication within the ERSPC was changed from a PSA cut‐off of 4.0 ng/ml and/or abnormal DRE/TRUS (group‐1) to solely a PSA cut‐off of 3.0 ng/ml (group‐2). We estimated the effect of omitting DRE/TRUS by comparing the results of a re‐screening 4 years after initial screening to the original policy. METHODS We compared rate and characteristics of detected PCs in the second round in men initially screened in group‐1 (N = 5,957) or group‐2 (N = 8,044). Additionally, we compared the rate of interval cancers (ICs) after screening with and without DRE/TRUS. RESULTS There was no significant difference in second round cancer‐detection‐rates (group‐1, 3.0%; group‐2, 2.7%), positive‐predictive‐values (group‐1, 23.9%; group‐2, 26.3%), and number of poorly‐differentiated tumors (group‐1, 2.6%; group‐2, 3.8%). Most PCs were clinically confined to the prostate. Eleven ICs were detected in each group (0.18 and 0.14%). CONCLUSIONS Omitting DRE/TRUS did not result in an increased IC‐ or PC‐detection. However, considering the natural history of PC, the 4‐year follow‐up may be too short to draw a definitive conclusion. Prostate 66:625–631, 2006. © 2005 Wiley‐Liss, Inc.

Prostate Specific Antigen Best Practice Statement: 2009 Update

“…However, data from the ERSPC found that DRE did not improve prostate cancer screening over PSA testing alone. 13 …”

Association of prostate volume with incidence and aggressiveness of prostate cancer

“…Serum PSA levels of >4.0 ng/mL has a sensitivity of ~20% and a specificity in the range of 60–70% 5. The low sensitivity may be due to the fact that PSA serum levels can be elevated in the presence of benign pathology such as BPH and prostatitis.…”

Rural‐Urban Differences in Prostate‐Specific Antigen (PSA) Screening and Its Outcomes in New Zealand

“…New Zealand has one of the highest incidence rates of prostate cancer worldwide, probably due to high rates of PSA testing . The level of PSA is currently considered to be the best single test for early prostate cancer detection, despite its limitations . The PSA test is used either for screening of asymptomatic men, or as an aid for prostate cancer detection in symptomatic men and for monitoring the progress of prostate cancer after diagnosis …”

“…1,13 The level of PSA is currently considered to be the best single test for early prostate cancer detection, despite its limitations. 14,15 The PSA test is used either for screening of asymptomatic men, or as an aid for prostate cancer detection in symptomatic men and for monitoring the progress of prostate cancer after diagnosis. 15,16 There is persisting uncertainty about the benefits and harms of population-based screening for prostate cancer.…”