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606Five-year prostate cancer screening program in high risk families: Results in young first degrees relatives aged 40–49
605
606
PSA-TESTING IN GENERAL PRACTICE. A SURVEY A M O N G 325 GENERAL PRACTITIONERS IN D E N M A R K
FIVE-YEAR PROSTATE CANCER SCREENING P R O G R A M IN HIGH RISK FAMILIES: RESULTS IN YOUNG FIRST DEGREES RELATIVES AGED 40-49
Jonler M J, Eddy B. 2, Poulsen j.x XAalborg Hospital, Department of Urology, Aalborg, Denmark, aKings College Hospital, Department of Urology, London, United Kingdom INTRODUCTION & OBJECTIVES: PSA is a well known and utilized mmour marker for prostate cancer. Elevated PSA is not specific for prostate cancer as other benign conditions might cause elevated values. PSA testing is widely used by urologists and non-urologists. However, interpretation of test results is difficult but important. Patients' referral for further workup on suspicion of prostate diseases is mainly done by general practitioners (GPs). Since the GP remains the patients' gatekeeper in diagnosing prostate diseases, basics knowledge about PSA testing is crucial. The purpose of the present study was to evaluate the basic use and knowledge of PSA testing and to give an estimate of the need for further education in PSA testing amongst GPs in our area. MATERIAL & METHODS: A detailed questionnaire regarding PSA testing and associated needs for education was mailed to all GPs in the Northern County of Denmark. Non-respondents were contacted by mail after a fixed deadline had passed. RESULTS: 90% of all the contacted GPs responded. Only 28% of the GPs measured PSA in all males complaining of LUTS. In patients seen as part of a general health-test PSA testing was done in 10%. Median PSA value for referral to urologists work-up was 5 ng/ml but the decision was influenced by PSA value (79%), age (65%), and findings on DRE (87%). Systematic screening for prostate cancer was done by 14% of GPs. 24% of the GPs answered that they did not need any further education in PSA testing. CONCLUSIONS: This study demonstrates that PSA testing is not standardized in our area. GPs do not test patients on the basis of recommendations provided from national or international societies. PSA testing is not used as a standard test in men with LUTS and patients are not referred to urologists at a sufficiently low PSA level to improve early diagnosis and work-up of patients with suspected prostate cancer. However, many GPs decision for further workup by urologists is influenced by findings on DRE, patients' age, and the PSA value itself. Further education in PSA testing amongst GPs in our area seems appropriate.
Valeri AJ, Moineau M.P.2, Joulin V?, Azzouzi R. 3, Doucet L. 4, Cancel-Tassin G. s, Cormier L?, Mangin R 3, Cussenot 0. 6, Foumier G. 1, CeRePP, Paris, France tUniversity Hospital, Department of Urology, Brest, France, 2University Hospital, Lab. Nuclear Medicine, Brest, France, 3University Hospital, Department of Urology, Nancy,. France, 4University Hospital, Department of Pathology, Brest, France, 5University Saint-P~res, Genetic Lab., Paris, France, 6University Hospital Tenon, Department of Urology, Paris, France INTRODUCTION & OBJECTIVES: Targeted screening in high risk families due to familial aggregation is recommended as early as 40-45 years in first degree relatives (FDR) of CaP patients according to high risk and early onset of the disease. We aimed to assess this concept in FDR 40-49 years old (yo). MATERIAL & METHODS: We obtained a semm PSA testing, yearly, in a 5-year CaP screening program, in 344 FDR (brothers or sons), 40-49 yo, 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: i-7), so the screened men were classified into: hereditary status (3+ CaP: 11.3%), familial without obvious hereditary pattern (2CAP:19.2%) or sporadic (1CAP:69.5%). RESULTS: 344 individuals (mean age 45 y) had the first assessment, and to date 306, 290, 248 and 172 had respectively, the 2nd, 3ra, 4 rh, 5~hround PSA testing. Of the 344 screened men, 21 (6.1%) had at least one PSA level >4ng/ml of the 5 assessments. Prostatic biopsies diagnosed 4 CaP (1.2%) (pT2NOM0) in 43, 45, 46 and 48 yo men, were negative in 6 relatives, were not done in 7 cases (1 refusal, 1 due to other treated cancer; 5 due to control PSA <4ng/ml including 3 cases <2ng.ml). Four biopsies should be performed shortly. Although higher, the proportion of men with PSA >4ng/ml in 2+ CaP families (8.6% vs. 5%) and in early onset CaP (<65y) families (9.2% vs. 5%) was not significantly different (p=0.2 and 0.16). However 16/344 men (4.7%) had at least one PSA level _>2.5ng/ml and _<4ng/ml, and no value >4ng/ml, (med PSA: 2.76; reed PSAf/t: 19.6%; reed age 48.5 y), of whom 4 (1.2%) had PSAf/t<15%. Moreover biopsies policy has been changed since a few months, using a lower ant-off of 2.5ng/ml and an additional CaP has been diagnosed (43 yo, PSA: 3.23ng/ml). CONCLUSIONS: Those results suggest that CaP is not frequent in 40-49 yo FDR. However 16 men (4.7%) had PSA level >_2.5ng/ml and <4ng/ml, suggesting potentially misdiagnosed CaP. The number of CaP that will be diagnosed after lowering the PSA cut-offto 2.5ng/ml, will help to define screening modalities in this high risk population (age to start, PSA cut-off and interest of free PSA).
608
607 THE EFFECT OF BICYCLE RIDING ON PSA
Tariel E?, Resche-Rigon M. 2, Cardot V. ~, Meria p.1, Cortesse A. 1, Desgrandchamps F. 1, Teillac R 1 ~Saint Louis, Urology, Paris, France, 2Saint Louis, Biostatistique et Iformatique M6dicale, Paris, France INTRODUCTION & OBJECTIVES: To investigate whether bicycle riding
significantly alters total prostate-specific antigen (tPSA), free PSA (fPSA) and percent free PSA (%fPSA) serum concentrations. MATERIAL & METHODS: A total of 133 cyclists, ranging in age from 34 to
73 years (mean 54.4), who run the Paris - Nice cyclo (race of 1500 km in 9 stages, over 15 days), were investigated. They complete a questionnaire (age, weight, size, IPSS). Blood samples for PSA analysis were drawn before and after the race. Coefficients of variations of tPSA and fPSA were calculated ([PSAafterPSAbefore]/PSAbefore). Paired Student test was performed to analyse the data. RESULTS: Before the race, mean t P S A - 1.63 ng/ml (+/- 1.80), ranging from 0.26 to 13.25 ng/ml (median 1.05). Mean fPSA - 0.40 ng/1 (+/- 0.35), ranging
from 0.07 to 1.99 ng/ml (median 0.29). After the race, mean tPSA = 1.62 ng/ml (+/- 2.35), ranging from 0.13 to 21.1 ng/ml (median 0.92). Mean fPSA = 0.37 ng/1 (+/- 0.41), ranging from below 0.05 to 2.62 ng/ml (median 0.22). There is a decrease of tPSA and fPSA during the race, thus tPSA coefficient of variation is significantly below zero (p=8.8.10 -5) and the fPSA coefficient of variation is also below" zero (19=2.5.10 s). %fPSA also decrease (p=0.002). CONCLUSIONS: The practice of cycling reduces significantly tPSA, fPSA and
%fPSA.
European Urology Supplements 4 (2005) No. 3, pp. 154
COMPLICATION RATES OF 6272 TRANSRECTAL, ULTRASOUND (TRUS) GUIDED BIOPSIES OF THE PROSTATE: RESULTS FROM THE TYROL PSA SCREENING STUDY
Horuinger W.1, Berger A. 1, Pelzer A?, Bektic J.1, Franscher F.2, Pallwein L.2, Klocker H. 1, Bartsch G. ~ ~Medical University of Innsbmck, Dept. of Urology, Innsbruck, Austria, ZMedical University of Innsbruck, Dept. of Radiology, Innsbmck, Austria INTRODUCTION & OBJECTIVES: To evaluate the complication rates of TRUS guided prostate biopsies in a healthy screening population. MATERIAL & METHODS: Between January 1993 and October 1995 sextant biopsies, between November i995 and February 2000 10 systematic biopsies and since then 5 additional targeted biopsies of the prostate were performed. All screening volunteers received oral proplylactic antibiotic therapy (ciprofloxacin 250 mg twice dally) starting one day before the procedure. Complications were categorized in minor complications (haematuria >1 day, hematospermia, rectal bleeding <2 days) and major complications (prostatitis, epididymitits, fever > 38°C, rectal bleeding >2 days and/or requiring surgical intervention, urinary retention, other complications requiring hospitalisation). Complication rates were assessed by a physician either in a personal interview or by phone. RESULTS: 6272 biopsies were perfon~aedin 4704 men. Haematuria and haemospermia were the most frequent reported side effects occurring in 12.9% and 41.7%, respectively. Further data are shown in the table below.
minor complications: haematuria > 1 day haemospermia rectal bleeding < 2 days major complications: prostatitis epididymitis fever > 38°C rectal bleeding > 2 days and/or requiring surgical intervention urinary retention other complications requiring hospitalisation
12.9% 41.7% 1.5% 0.8% 0.9% 0.5% 0.5% 0.2% 0.3%
CONCLUSIONS: Haematuria and haemospermia are frequently reported, however, they cause minimal discomfort and require no additional treatment; major complications requiring hospitalisation were rare. According to these data TRUS-guided prostate biopsy is a safe procednre in a healthy screening population.
606
PSA-TESTING IN GENERAL PRACTICE. A SURVEY A M O N G 325 GENERAL PRACTITIONERS IN D E N M A R K
FIVE-YEAR PROSTATE CANCER SCREENING P R O G R A M IN HIGH RISK FAMILIES: RESULTS IN YOUNG FIRST DEGREES RELATIVES AGED 40-49
Jonler M J, Eddy B. 2, Poulsen j.x XAalborg Hospital, Department of Urology, Aalborg, Denmark, aKings College Hospital, Department of Urology, London, United Kingdom INTRODUCTION & OBJECTIVES: PSA is a well known and utilized mmour marker for prostate cancer. Elevated PSA is not specific for prostate cancer as other benign conditions might cause elevated values. PSA testing is widely used by urologists and non-urologists. However, interpretation of test results is difficult but important. Patients' referral for further workup on suspicion of prostate diseases is mainly done by general practitioners (GPs). Since the GP remains the patients' gatekeeper in diagnosing prostate diseases, basics knowledge about PSA testing is crucial. The purpose of the present study was to evaluate the basic use and knowledge of PSA testing and to give an estimate of the need for further education in PSA testing amongst GPs in our area. MATERIAL & METHODS: A detailed questionnaire regarding PSA testing and associated needs for education was mailed to all GPs in the Northern County of Denmark. Non-respondents were contacted by mail after a fixed deadline had passed. RESULTS: 90% of all the contacted GPs responded. Only 28% of the GPs measured PSA in all males complaining of LUTS. In patients seen as part of a general health-test PSA testing was done in 10%. Median PSA value for referral to urologists work-up was 5 ng/ml but the decision was influenced by PSA value (79%), age (65%), and findings on DRE (87%). Systematic screening for prostate cancer was done by 14% of GPs. 24% of the GPs answered that they did not need any further education in PSA testing. CONCLUSIONS: This study demonstrates that PSA testing is not standardized in our area. GPs do not test patients on the basis of recommendations provided from national or international societies. PSA testing is not used as a standard test in men with LUTS and patients are not referred to urologists at a sufficiently low PSA level to improve early diagnosis and work-up of patients with suspected prostate cancer. However, many GPs decision for further workup by urologists is influenced by findings on DRE, patients' age, and the PSA value itself. Further education in PSA testing amongst GPs in our area seems appropriate.
Valeri AJ, Moineau M.P.2, Joulin V?, Azzouzi R. 3, Doucet L. 4, Cancel-Tassin G. s, Cormier L?, Mangin R 3, Cussenot 0. 6, Foumier G. 1, CeRePP, Paris, France tUniversity Hospital, Department of Urology, Brest, France, 2University Hospital, Lab. Nuclear Medicine, Brest, France, 3University Hospital, Department of Urology, Nancy,. France, 4University Hospital, Department of Pathology, Brest, France, 5University Saint-P~res, Genetic Lab., Paris, France, 6University Hospital Tenon, Department of Urology, Paris, France INTRODUCTION & OBJECTIVES: Targeted screening in high risk families due to familial aggregation is recommended as early as 40-45 years in first degree relatives (FDR) of CaP patients according to high risk and early onset of the disease. We aimed to assess this concept in FDR 40-49 years old (yo). MATERIAL & METHODS: We obtained a semm PSA testing, yearly, in a 5-year CaP screening program, in 344 FDR (brothers or sons), 40-49 yo, 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: i-7), so the screened men were classified into: hereditary status (3+ CaP: 11.3%), familial without obvious hereditary pattern (2CAP:19.2%) or sporadic (1CAP:69.5%). RESULTS: 344 individuals (mean age 45 y) had the first assessment, and to date 306, 290, 248 and 172 had respectively, the 2nd, 3ra, 4 rh, 5~hround PSA testing. Of the 344 screened men, 21 (6.1%) had at least one PSA level >4ng/ml of the 5 assessments. Prostatic biopsies diagnosed 4 CaP (1.2%) (pT2NOM0) in 43, 45, 46 and 48 yo men, were negative in 6 relatives, were not done in 7 cases (1 refusal, 1 due to other treated cancer; 5 due to control PSA <4ng/ml including 3 cases <2ng.ml). Four biopsies should be performed shortly. Although higher, the proportion of men with PSA >4ng/ml in 2+ CaP families (8.6% vs. 5%) and in early onset CaP (<65y) families (9.2% vs. 5%) was not significantly different (p=0.2 and 0.16). However 16/344 men (4.7%) had at least one PSA level _>2.5ng/ml and _<4ng/ml, and no value >4ng/ml, (med PSA: 2.76; reed PSAf/t: 19.6%; reed age 48.5 y), of whom 4 (1.2%) had PSAf/t<15%. Moreover biopsies policy has been changed since a few months, using a lower ant-off of 2.5ng/ml and an additional CaP has been diagnosed (43 yo, PSA: 3.23ng/ml). CONCLUSIONS: Those results suggest that CaP is not frequent in 40-49 yo FDR. However 16 men (4.7%) had PSA level >_2.5ng/ml and <4ng/ml, suggesting potentially misdiagnosed CaP. The number of CaP that will be diagnosed after lowering the PSA cut-offto 2.5ng/ml, will help to define screening modalities in this high risk population (age to start, PSA cut-off and interest of free PSA).
608
607 THE EFFECT OF BICYCLE RIDING ON PSA
Tariel E?, Resche-Rigon M. 2, Cardot V. ~, Meria p.1, Cortesse A. 1, Desgrandchamps F. 1, Teillac R 1 ~Saint Louis, Urology, Paris, France, 2Saint Louis, Biostatistique et Iformatique M6dicale, Paris, France INTRODUCTION & OBJECTIVES: To investigate whether bicycle riding
significantly alters total prostate-specific antigen (tPSA), free PSA (fPSA) and percent free PSA (%fPSA) serum concentrations. MATERIAL & METHODS: A total of 133 cyclists, ranging in age from 34 to
73 years (mean 54.4), who run the Paris - Nice cyclo (race of 1500 km in 9 stages, over 15 days), were investigated. They complete a questionnaire (age, weight, size, IPSS). Blood samples for PSA analysis were drawn before and after the race. Coefficients of variations of tPSA and fPSA were calculated ([PSAafterPSAbefore]/PSAbefore). Paired Student test was performed to analyse the data. RESULTS: Before the race, mean t P S A - 1.63 ng/ml (+/- 1.80), ranging from 0.26 to 13.25 ng/ml (median 1.05). Mean fPSA - 0.40 ng/1 (+/- 0.35), ranging
from 0.07 to 1.99 ng/ml (median 0.29). After the race, mean tPSA = 1.62 ng/ml (+/- 2.35), ranging from 0.13 to 21.1 ng/ml (median 0.92). Mean fPSA = 0.37 ng/1 (+/- 0.41), ranging from below 0.05 to 2.62 ng/ml (median 0.22). There is a decrease of tPSA and fPSA during the race, thus tPSA coefficient of variation is significantly below zero (p=8.8.10 -5) and the fPSA coefficient of variation is also below" zero (19=2.5.10 s). %fPSA also decrease (p=0.002). CONCLUSIONS: The practice of cycling reduces significantly tPSA, fPSA and
%fPSA.
European Urology Supplements 4 (2005) No. 3, pp. 154
COMPLICATION RATES OF 6272 TRANSRECTAL, ULTRASOUND (TRUS) GUIDED BIOPSIES OF THE PROSTATE: RESULTS FROM THE TYROL PSA SCREENING STUDY
Horuinger W.1, Berger A. 1, Pelzer A?, Bektic J.1, Franscher F.2, Pallwein L.2, Klocker H. 1, Bartsch G. ~ ~Medical University of Innsbmck, Dept. of Urology, Innsbruck, Austria, ZMedical University of Innsbruck, Dept. of Radiology, Innsbmck, Austria INTRODUCTION & OBJECTIVES: To evaluate the complication rates of TRUS guided prostate biopsies in a healthy screening population. MATERIAL & METHODS: Between January 1993 and October 1995 sextant biopsies, between November i995 and February 2000 10 systematic biopsies and since then 5 additional targeted biopsies of the prostate were performed. All screening volunteers received oral proplylactic antibiotic therapy (ciprofloxacin 250 mg twice dally) starting one day before the procedure. Complications were categorized in minor complications (haematuria >1 day, hematospermia, rectal bleeding <2 days) and major complications (prostatitis, epididymitits, fever > 38°C, rectal bleeding >2 days and/or requiring surgical intervention, urinary retention, other complications requiring hospitalisation). Complication rates were assessed by a physician either in a personal interview or by phone. RESULTS: 6272 biopsies were perfon~aedin 4704 men. Haematuria and haemospermia were the most frequent reported side effects occurring in 12.9% and 41.7%, respectively. Further data are shown in the table below.
minor complications: haematuria > 1 day haemospermia rectal bleeding < 2 days major complications: prostatitis epididymitis fever > 38°C rectal bleeding > 2 days and/or requiring surgical intervention urinary retention other complications requiring hospitalisation
12.9% 41.7% 1.5% 0.8% 0.9% 0.5% 0.5% 0.2% 0.3%
CONCLUSIONS: Haematuria and haemospermia are frequently reported, however, they cause minimal discomfort and require no additional treatment; major complications requiring hospitalisation were rare. According to these data TRUS-guided prostate biopsy is a safe procednre in a healthy screening population.