ml?

385 PROSTATE PROTOCOL

CANCER AT INITIAL

SCREENING: AND SECOND

THE SAME SCREENING SCREENING ROUND?

386

Roobol M., De Vries S., SchrBder F.

SCREENING REVIEW EDUCATION PHYSICIANS

Erasmus MedIcal Centre, Department of Urology, Rotterdam, The Netherlands

Garnick M.

INTRODUCTION & OBJECTIVES: In the European Random&d Study of Screening for Prostate Cancer (ERSPC. sectlon Rotterdam) the first step is B sexurn PSA determination. All men (age 55.74) with a PSA >= 3.0 “g/ml are considered to be at higher risk in having prostate cancer and therefore are further examined by means of a DRE, TRUS and sextant biopsies (SB). The sensitivity for slgnalling the presence of prostate cancer (PC) is limited by poor specificity (e.g. BPH) and thus triggers the performance of many pate&ally unnecessary SB, especially in men who already have experienced a negative SB, indlcated due to a PSA ,= 3.0 rig/ml at 1If screening. MATERIAL & METHODS: PPV’s (number of PC detected divided by number of SB taken) per PSA level of 3201 men biopsied at 1” screening round (group l), 1926 men biopsied at 2”” screening round so far (group 2, 386 cancers) were calculated. Group 2 was subdivided into two groups, group3) men wth a previous negative SB, initial PSA >= 3.0 and prostate volume >= 50.0 ml (n = 471, 43 cancers) and group 4) the rest of the biopsies of group 2 (n = 1455, 343 cancers). Turnour characteristics of cancers detected in men of group 3 were assessed.

Harvard

FOR PROSTATE CANCER: AN EVIDENCE BASED UTILIZING THE PHYSICIANS’ INFORMATION AND RESOURCE OF THE AMERICAN COLLEGE OF

Medical School, Department

of Medicine,

Boston Massachusetts,

United States

INTRODUCTION & OBJECTIVES: The Physiclam’ Information and Education Resource (PIER) is a web-based medical resource sponsored by the American College of Physicians designed for physicians to provide rapid and accurate “point-of-care” information and evidence-based guidance. PIER provides evidence-based guidance statements about specific topics and then utilizes an interactive format that allows expansion of data presentation, guidance, and treatment recommendations with links to summary statements and medical literature citations. Key PIER “screening for prostate cancer” points include populations at risk, effectiveness/harms of screening tests and treatment, evidence that screening alters adverse outcomes, recommendations for performing screening tests, cost effectiveness, and receiver operating characteristics (ROC) of screening tests. MATERIAL & METHODS: Nearly 3,000 articles and abstracts and reviews related to prostate cancer screening from European, North American, and Japanese medical jomnals in English were reviewed. Studies that were based upon randomized controlled clinical studies (Evidence level A), or cohort, case-control, observational or case series (Evidence level B) were emphasized. All Pub Med identification (PMID) numbers were included in the module and are accessible.

RESULTS: I

PPV’s in group 3 are substantially lower as compared to the PPV’s ofmen in group 4. Not biopsying men in group 3 would result in 471 less SB (24% of 1926) and a lass of 43 (11 % of 386) PC cases (taking a volume cut-off of 55.0 ml shows comparable results), PPV’s at 2”d screening would rise substantially, especially in the higher PSA ranges (group 4). Clinical stage distribution of the 43 cancers of group 3 is: 27 TlC, 15 T2 and 1 T3A, Gleason score distribution: 2+2 (I), 3+3 (39), 3+4 (2) and 4+4 (1). Remarkably is that 22 of the 43 (51.2 %) cancers were diagnosed in men older than 70 years of age (n = 184). In group 4 this percentage is 28.9 %. CONCLUSIONS: We have identified a group of men in whom, at the 2”d screening visit of ERSPC, the probability to detect PC was low (volume >= 50 ml, a negative previous biopsy and PSA >= 3.0 at the initial screening visit). This finding suggests that maybe it is better to biopsy on indication of the estunated probability to detect PC instead of using a fixed PSA threshold. However. before any definitive guidelines can be given in this respect we will have to wait until the final analysis of ERPSC has been completed in which the balance of the positive and negative aspects of screening for prostate cancer ~111be assessed. Data on treatment and progression will be presented.

RESULTS: Screening studies demonstrate rhat the natural history of untreated prostate cancer is variable, with certain subsets living for extended periods of time without active treatment intervention. Data reviewed from the ERSPC, PLCO, the USPSTF, and SEER have identified the risks and benefits of screened versus unscreened patient populations. The evolution of the historically utilized screening tests of digital rectal examination, prostate specific antigen (PSA), and transrectal ultrasound to more common use of only the PSA test has been evaluated systematically. Novel PSA indices (e.g. PSA velocity, PSA-TZ, age specific ranges and new isoforms of PSA) may enhance ROC. High risk groups - men with a family history, African Americans, obese men have been identified. CONCLUSIONS: While both the risks and benefits of prostate cancer treatment are well defined as a result of ongoing screening studies that involve nearly 400,000 men in Europe and North America, the overall benefit, as measured by prostate cancer disease specific survival and overall survival compared to unscreened, and hence, untreated populations, must await the maturation of the large ongoing ERSPC and PLCO studies, available in the 2005-2008 timeframe. Evidence based information from Evidence Level A and B publications provide critical knowledge to aid the practicing physician in decision making about screening for prostate cancer, and counselling patients and families about screening and treatment choices.

387 PROSTATE CANCER FAMILY HISTORY Gschwend

SCREENING

Herkommer

K.‘,

J.‘, Kron

‘University Department

of Ulm, Department of Biometry, Ulm,

IN M.*,

PERSONS Hautmann

of Urology, Germany

Ulm,

WITH

A POSITIVE

R.‘, Paiss T.’ Germany,

‘University

of Ulm,

MATERIAL & METHODS: 846 first degree relatives (brothers) of patients with or without a positive family history and 26 1 control persons were asked to undergo a screening test for prostate cancer. They were informed about PC in general and their own PC risk. 495 brothers of PC patients underwent a screening test: 110 PC patients had a sporadic PC diagnosed at an age < 56 years (young sporadic group), 174 had a sporadic PC diagnosed at an age > 55 years (older sporadic group), and 211 a familial PC (familial group). These data were compared to screening data of 118 control persons (control group). The screening consisted of a digitorectal examination lOO%, PSA-test in 90% and a transrectal ultrasound in 79%. The mean age of the screened persons was between 56 and 62 years in all groups. For the rate of detected PC a 95% confidence interval was calculated. To compare PCdetection rates between groups screened the (X-Square test was used. RESULTS: The proportion of detected PC in the familial group, the young sporadic group and the older sporadic group was 6.5% (95%CI: 4.5%-9.0%) compared to the proportion in the control group with 0% (95%CI: O%-3.1%; p= 0.005). The proportion of detected PC in the familial group was 7.6% (95%CI: 4.4%-12.0%) compared to the proportion in the young and older sporadic group with 5.6% (95%CI: 3.3%-9.0%; p=O.38). The proportion of detected PC in the young sporadic group was 6.4% (95%CI: 2.6%-12.7%) compared to the older sporadic group with 5.2% (95%CI: 2.4%-9.6%; p=O.67). CONCLUSIONS: A history of even one first degree relative prostate cancer significantly increases the probability of detecting PC in a screening examination, especially in relatives of younger PC patients. The risk is highest for persons with a history of familial prostate cancer. support:

Deutsche

Krebshilfe

(70-2179.Vo

Valeri A.‘, Moineau Mangin P.3, Cussenot ‘University

INTRODUCTION & OBJECTIVES: Prostate cancer (PC) screening is discussed controversial. A positive family history is one of the strongest risk factors to develop prostate cancer. The aim of this study was to investigate the rate of detected PC in persons with or without a positive family history.

Grant

388 PROSTATE CANCER SCREENING IN HIGH RISK FAMILIES: PSA TESTING BE PERFORMED YEARLY IN FIRST RELATIVES WITH BASELINE PSA <=lNG/ML?

I)

M.P.2, Joulin V.l, Cornier 0.6, Morin J.F.2, Foumier G.l

Hospital,

Department

of Urology,

L.3, Azzouzi

Brest,

France,

Department of Nuclear Medicine, Brest, France, Wniversity Urology, Nancy, France, Qniversity Hospital, Department United Kingdom,

University

5University

Hospital,

INTRODUCTION familial aggregation (FDR)

Hospital,

Department

& OBJECTIVES: is recommended

of CaP patients

according

MATERIAL

R.“:

Doucet

*University

L.5:

Hospital,

Hospital, Department of of Urology, Sheffield,

of Pathology,

Brest, France, “Tenon

Paris, France

Targeted

screening

in high risk families

due to

as early as 40-45 years in first degree relatives

to high risk and early onset of the disease.

to assess if PSA testing is necessary is <=l rig/ml. PSA testing aged 40-49

Department

of Urology,

SHOULD DEGREE

We aimed

once a year in FDR aged 40-70, when baseline PSA

& METHODS: Since 1999, we performed a CaP screening by serum yearly, in a 3.year screening program, in 649 FDR (brothers or sons) (343 and 306 aged 50-70) of CaP patients treated, between 1994-1997. A

systematic genealogical analysis previously performed, allowed to define the familial CaP status, at least 1 CaP in the family (range: l-7): hereditary status (3+ CaP; lO.S%), familial without obvious hereditary pattern (2CaP; 17.8%) or sporadic (ICaP; 71.7%). RESULTS: Of the 649 FDR, 328 (50.5%, med. age: 47~) had a PSA level <=lng/ml. Of these 328 men, 301 (91.8%) and 280 (85.4%) had their second and third year assessment Among these 280 relatives, 4 men (1.4%) had a PSA level >2.5ng/ml at the second screening round: 2 of them with PSA >4ng/ml refused biopsies and had PSA <=lng/ml

one year later; the 2 others

had a PSA level 12.5 rig/ml at the 31~ evaluation.

Among the 280 men with baseline PSA <=lng/ml, who underwent the 3 screening rounds, 3 men with their 2 first PSA levels 2.5ng/ml: one with PSA= 5.8ng/ml (PSAf/t=5.5%) bad negative biopsies, another with PSA=lOng/ml who wanted a PSA test control before biopsies, was considered without CaP as the control test showed a low level (0.86 ngiml), the 3”’ relative (53 yo) with PSA ~2.9 rig/ml (PSAf/t=lh.9%) will undergo shortly prostatic biopsies. In summary only 11280 (0.36%) men with baseline PSA <=lng/ml, may have CaP 2 years after is first evaluation. CONCLUSIONS: Our results suggest to perform PSA testing only every 2 years in selected first degree relatives of CaP patients, with baseline PSA level <=lngiml. The long term results of such a screening suggestion is reasonable.

European

program

Urology

at 5 years and more will confirm

Supplements

3 (2004)

if this

No. 2, pp. 99