Serum Prostate Specific Antigen as Pre-Screening Test for Prostate Cancer

Labrie, Fernand; Dupont, André; Suburu, Raul; Cusan, Lionel; Tremblay, M.; Gomez, José‐Luis; Emond, Jean

doi:10.1016/s0022-5347(17)37402-5

Cited by 323 publications

(133 citation statements)

References 43 publications

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“…It is simply a red light indicating that the diagnosis of prostate cancer is a significant possibility which should be eliminated by other tests. 10,24 In fact, PSA is clearly the easiest, most widely available, most efficient, less invasive and less costly technique among all the diagnostic procedures available to diagnose and follow any type of cancer.…”

Section: Discussionmentioning

confidence: 99%

“…10,14 In the ERSPC study, after initial screening, screening was only offered every 4 years or once after 4 years. 25 As a result, after 11 years of follow-up, PSA testing had been done on average only 2.27 times per man over the 11-year period, including first screening for a median interval of 4.02 years between screenings 12 ( Table 1).…”

Section: Psa Screening Intervalmentioning

confidence: 99%

“…A cutoff value of 4.0 ng ml 21 PSA was used in the US study, thus missing cancers between 3.0 and 4.0 ng ml 21 PSA. 10,15 . Both the European and Canadian studies used a PSA cutoff value of 3.0 ng ml 21 .…”

Section: Psa Cutoff Valuesmentioning

confidence: 99%

“…We then decided to start in 1988 the first randomized and prospective trial of screening for prostate cancer with the hope of being able to diagnose the disease at the localized, asymptomatic and only potentially curable stage. 10,11 Results of prospective and randomized screening studies An update at 11 years of follow-up of the ERSPC which started in 1991 with last enrolment in 2003 (162 388 men aged 55-69 years of age) shows a 21% reduction (95% confidence interval (CI): 0.68-0.91) in the rate of prostate cancer deaths with 299 deaths from prostate cancer in the screened group and 462 in the control group 12 (Table 1). During years 10 and 11 of follow-up, the relative risk reduction was 38% (95% CI: 0.45-0.85, P50.003), an observation expected from the long time survival of men diagnosed with early prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

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PSA screening for prostate cancer: why so much controversy?

Labrie

2013

Asian J Androl

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Since prostate cancer reaches the advanced and non curable stage in the absence of any specific symptom or sign, it seems reasonable to diagnose this cancer at an early and curable stage. Screening by prostate-specific antigen (PSA) has been the common technology used. The last follow-up of the first two prospective and randomized screening studies for prostate cancer, namely the Quebec and ERSPC (European Randomized Study of Screening for Prostate Cancer) clinical trials started in 1988 and 1991, respectively, have shown reductions of prostate cancer death of 62% (P,0.002) and 21% (P,0.001) (38% in the tenth and eleventh years of follow-up, P,0.003), respectively, while the PLCO (Prostate Lung Colorectal and Ovarian Cancer) screening trial reported no benefit. It has been estimated, however, that 85% of men in the planned 'non-screened' group of the US study have been screened. With such a serious flaw, the PLCO study does not have the statistical power to reach any valid conclusion. In the Quebec study, only 7.3% of men were screened in the control arm. The important benefit observed in the ERSPC study was achieved using a less than optimal 4-year PSA screening interval which misses a significant number of cancers while the Quebec study used the optimal 1-year interval. With proper information obtained from their physicians or otherwise using data collected only from the clinical trials having the required statistical power, men should be in a good position to decide about being or not being screened for prostate cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Psa Screening Intervalmentioning

confidence: 99%

Section: Psa Cutoff Valuesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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PSA screening for prostate cancer: why so much controversy?

Labrie

2013

Asian J Androl

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“…In the design of this investigation, the observation in 1992 by Labrie that 3.0 ng/mL, represents the more appropriate PSA cutoff, was utilized. 8 Labrie noted that with a PSA greater than 3.0 ng/mL, the risk of prostate cancer in an initial screening evaluation is approximately 20%. In contrast, those with a PSA less than 3.0 ng/mL have a risk of approximately 1%.…”

mentioning

confidence: 99%

Prostate cancer: epidemiology and screening

1999

Prostate Cancer Prostatic Dis

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Six major presentations covered virtually all aspects of the epidemiology of and for screening prostate carcinoma. Dr Richard Middleton, Professor and Chairman of the Department of Urology at the University of Utah, discussed the changing incidence and presentation of prostatic carcinoma. He derived the majority of the data presented in his talk from the Utah SEER (Surveillance, Epidemiology, and End Results) statistics. This highly respected cancer registry provided great insight into the changing incidence and prevalence of prostate cancer in the United States. There are 10 SEER registries throughout the US, of which Utah is one of the most highly regarded. Dr Middleton illustrated that in the National SEER registry, the incidence of prostate cancer peaked in 1992 in Caucasians, and a year later in African-Americans and subsequently has decreased (Figure 1). Moreover, there has been a signi®cant decrease in more advanced prostate cancer since 1993 as illustrated in Figure 2. Interestingly, we have previously reported that in Western Washington SEER registry, the incidence of prostate cancer peaked a year before the National SEER registry, undoubtedly owing to increased interest in prostate cancer in general and, particularly, early detection and screening in the Northwest. 1 Dr Middleton provided additional information with respect to changing grade and stage of prostate cancer in the database. Table 1, for example, demonstrates the changes in the grade at presentation, along with the incidence of nodal metastases known at the time of radical prostatectomy between 1988 and 1994. Interestingly, there is a slight increase in moderately differentiated prostatic carcinoma (Gleason score 4 ± 8) over these years, but a decrease in both well differentiated and poorly differentiated carcinoma. As there is no central pathologic review, some of these changes may be associated with different expertise in the utility of the Gleason grading system by local pathologists over this period. Of great interest, and widely recognized throughout the United States, is the changing incidence of nodal metastasis, where we see a staggering decrease over these six years. Clearly prostate carcinoma is presenting at an earlier stage and thus more men are potentially curable.Dr Middleton went on to discuss a signi®cant problem in the literature: the relative paucity of data with

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An Evaluation of Prostate-Specific Antigen as a Screening Test for Prostate Cancer

Dorr

Williamson²,

Stephens³

1993

Arch Intern Med

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Prostate cancer is the second leading cause of cancer death in men. Recently, there has been increased interest in the use of prostate-specific antigen (PSA) as a screening test for prostate cancer. The PSA test offers the benefit of a reproducible, objective value that is independent of the examiner's skill; however, it does not seem to be effective alone as a screening test for prostate cancer. Additionally, the efficacy of treatment for prostate cancer with radiation therapy or radical prostatectomy remains to be demonstrated. Thus, further studies demonstrating an improved mortality in prostate cancer with PSA screening need to be performed before universal screening with PSA can be recommended. Meanwhile, education of the patient regarding the risks, benefits, and costs of PSA screening and subsequent treatment should be addressed before performing a PSA test.

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Serum Prostate Specific Antigen as Pre-Screening Test for Prostate Cancer

Cited by 323 publications

References 43 publications

PSA screening for prostate cancer: why so much controversy?

PSA screening for prostate cancer: why so much controversy?

Prostate cancer: epidemiology and screening

An Evaluation of Prostate-Specific Antigen as a Screening Test for Prostate Cancer

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