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MASS SCREENING FOR PROSTATE CANCER IN KOREA: POPULATION-BASED STUDY
600
THE JOURNAL OF UROLOGY®
were continent (no pads) and potency could be preserved in 78.9% of men below 65 years of age. The morbidity associated with transrectal XOWUDVRXQGJXLGHGELRSV\ZDVORZ PDMRUFRPSOLFDWLRQVZHUHVHHQLQD small percentage of patients only (0.5% of patients with fevers higher WKDQ)UHTXLUHGKRVSLWDOL]DWLRQ 6LQFH DVLJQL¿FDQWUHGXFWLRQ in mortality from prostate cancer has been observed in the Tyrol. In the years 2003 - 2005 prostate cancer mortality rates decreased by 48%, 55%, and 52%, respectively. &21&/86,216 7KHVH¿QGLQJVFRQ¿UPWKHK\SRWKHVLVWKDW freely available PSA testing, which has met with wide acceptance in the population, is associated with a reduction in prostate cancer mortality in an area where effective treatment is freely available to all men. It is likely that much of this decline in mortality rates is due to earlier detection and successful treatment of prostate cancer. However, and important FRUROODU\LPSOLFDWLRQRIRXUVWXG\LVWKDWVFUHHQLQJLVRQO\WKH¿UVWVWHS in the optimal management of prostate cancer. Source of Funding: None
1750 MASS SCREENING FOR PROSTATE CANCER IN KOREA: POPULATION-BASED STUDY Cheryn Song*, Hanjong Ahn, Taekyun Kwon, Hyung-Jin Kim, Jong Yeon Park, Han-Yong Choi. Seoul, Republic of Korea, Daegu, Republic of Korea, Jeonju, Republic of Korea, and Gangneung, Republic of Korea. INTRODUCTION AND OBJECTIVE: Lowest incidence of prostate cancer in the Asian population as well as in Korea compared to the Caucasians has repeatedly been reported. However, lack of data from a systematic screening system may have impeded proper comparison and assessment. We investigated prevalence of prostate cancer in Korean men through population-based mass screening test. METHODS: In June 2007, serum PSA was examined in residents in Gangneung, Daegu and Jeonju areas aged 55 years RU ROGHU DQG 36$ QJPO ZDV VHW IRU VLWH WUDQVUHFWDO ELRSV\ recommendation. Numbers of participants were 1430 from Gangneung, 1396 from Daegu, and 1117 from Jeonju areas summing up to 3943 in WRWDO6HUXP36$GLVWULEXWLRQDQGFDQFHUGHWHFWLRQUDWHVZHUHDQDO\]HG according to the regions and age groups of the participants (55-64, 65-74, 75-84, over 85 years). RESULTS: Serum PSA of the entire cohort was 2.4±8.6 ng/ POVLJQL¿FDQWO\LQFUHDVLQJZLWKWKHLQFUHDVHRIDJH ng/ml for respective age groups, p<0.0001) but no regional differences were noted (2.2, 2.7, 2.3 ng/ml for Gangneung, Daegu, and Jeonju respectively, p=0.290). Biopsy candidates were 6.0%(40) of the 55-year age group, 16.5%(367) of the 65-year age group, 25.3%(238) of the 75-year age group, and 34.5%(38) of the 85-year age group constituting 18.3%(721) of the entire cohort. Of the biopsy candidates, 268(37.2%) had undergone biopsy and cancer was detected in 76(28.4%) of the biopsied participants rendering cancer detection and estimated cancer detection rates 1.93% and 5.17%, respectively. Age-adjusted HVWLPDWHG FDQFHU GHWHFWLRQ UDWH \HDUV ZDV &DQFHU GHWHFWLRQ LQFUHDVHG VLJQL¿FDQWO\ ZLWK WKH LQFUHDVH LQ 36$ DW 3.0-4.0ng/ml, 28.1% at 4.1-10.0ng/ml, 73.6% at >10.0ng/ml) and mean 36$ZDVVLJQL¿FDQWO\KLJKHULQWKHFDQFHUGHWHFWHG YVQJPO p<0.0001). Gleason score was 2-6 in 39(53.4%), 7 in 14(19.2%) and 8-10 in 20(27.4%). Mean Gleason score was 6.9 and no correlation with serum PSA was found. CONCLUSIONS: In the present population-based prostate cancer screening, estimated cancer detection rate in Korean men DJHG \HDUV RU ROGHU ZDV ZKLFK LV VLJQL¿FDQWO\ KLJKHU WKDQ UHSRUWVIURPRWKHU$VLDQFRXQWULHV6LJQL¿FDQFHRIWKHKLJKUDWHLQWKLV population should be determined through repeated screening and further surveillance in the future. Source of Funding:$VWUD=HQHFD.RUHD
Vol. 179, No. 4, Supplement, Wednesday, May 21, 2008
1751 PROSTATE SPECIFIC ANTIGEN TESTING AMONG THE ELDERLY: WHEN TO STOP? H Ballentine Carter, Anna E Kettermann*, Luigi Ferrucci, Patricia Landis, Bruce J Trock, E Jeffrey Metter. Baltimore, MD. ,1752'8&7,21$1'2%-(&7,9( 3URVWDWHVSHFL¿FDQWLJHQ (PSA) testing for prostate cancer is common in the elderly, but the value of continued screening in older men is unclear. We determined the proportion of men who developed aggressive prostate cancer by PSA and age to evaluate the safety of discontinuing PSA testing among older men. METHODS: The probability of aggressive prostate cancer (death from prostate cancer) by PSA and age was determined from a cohort of 849 men (122 with and 727 without prostate cancer) who were participating in the Baltimore Longitudinal Study of Aging (National Institute on Aging). Fisher’s exact test was used for comparisons between groups of men by age and PSA. RESULTS: Subjects with a PSA of 3.0ng/ml and above at the age of 75-80 years had a probability of death from prostate cancer DIWHUZDUGVWKDWFRQWLQXHGWRLQFUHDVH ZKHUHDVQRVXEMHFWDWWKHDJH of 75-80 years with a PSA below 3.0ng/ml died of prostate cancer afterwards (P<.001, Fisher’s exact test). These results were similar ZKHQDJJUHVVLYHSURVWDWHFDQFHUZDVGH¿QHGDVGHDWKIURPSURVWDWH cancer, or Gleason score 8 or above at diagnosis, or PSA 20ng/ml or above at diagnosis. CONCLUSIONS: Men who have a PSA level below 3ng/ml at age 75-80 years are unlikely to develop aggressive prostate cancer during their remaining life and for these men PSA testing might be safely discontinued. Source of Funding: Intramural Research Program of the NIH, National Institute on Aging.
1752 DECLARING A MORATORIUM ON REPEAT BIOPSIES: A NEW STATISTICAL METHOD FOR PREDICTING WHEN REPEAT PROSTATE BIOPSIES ARE UNNECESSARY Angela J Fought, Edward F Vonesh, Lee C Zhao*, Dae Y Kim, William J Catalona, Peter H Gann. Chicago, IL. INTRODUCTION AND OBJECTIVE: Patients with persistently elevated PSA and/or abnormal DRE with previous negative biopsies IDFH D GLI¿FXOW FRQXQGUXP DERXW KRZ PDQ\ ELRSV\ SURFHGXUHV DUH needed to rule out prostate cancer and at what time intervals they should be performed. In this study, we use a new statistical model for time-dependent covariates to quantify the risk for and time to subsequent prostate cancer diagnosis in men with previous negative prostate biopsies. METHODS: From 1991 to 2002, a total of 1,871 men were screened for prostate cancer for over 5 years, with 465 diagnosed with SURVWDWH FDQFHU :H DQDO\]HG WKLV FRKRUW LQ D SLHFHZLVH H[SRQHQWLDO survival analysis using covariates of age, race, any chronic urinary symptoms, TRUS volume (transrectal ultrasound of prostate in cc), PSA SURVWDWHVSHFL¿FDQWLJHQ 36$VORSHWLPHSULRUWR¿UVWELRSV\QXPEHU of biopsy cores obtained, number of repeat biopsies, atypical acinar proliferation (“atypia”) or high-grade prostatic intraepithelial neoplasia ³3,1´ RQWKH¿UVWELRSV\FKURQLFSURVWDWLWLVGLJLWDOUHFWDOH[DP '5( ¿QGLQJV VXVSLFLRXV IRU FDQFHU DQG '5( ¿QGLQJV DEQRUPDO EXW QRW suspicious for cancer. 5(68/76 7KH KD]DUG UDWLR HVWLPDWH XVLQJ WKH SLHFHZLVH exponential model with covariates equal 0.36 ± 0.17 (0.15-0.90 95% FRQ¿GHQFHLQWHUYDO IRUJUHDWHUWKDQUHSHDWELRSVLHVYHUVXVELRSVLHV Thus, after 3 negative biopsies, the model predicts the likelihood of having prostate cancer detected in future biopsies as low. A survival curve generated in Figure 1 displays the age-adjusted survival for patients with 2, 3, and greater than 3 repeat biopsies with subsets of varying PSA levels. CONCLUSIONS: In this study, using a piecewise exponential model, there is a clear association of decreased prostate cancer risk and increased survival with greater than 3 negative biopsies. This new statistical model may be useful to aid patients and physicians in determining the need for repeat biopsies.
THE JOURNAL OF UROLOGY®
were continent (no pads) and potency could be preserved in 78.9% of men below 65 years of age. The morbidity associated with transrectal XOWUDVRXQGJXLGHGELRSV\ZDVORZ PDMRUFRPSOLFDWLRQVZHUHVHHQLQD small percentage of patients only (0.5% of patients with fevers higher WKDQ)UHTXLUHGKRVSLWDOL]DWLRQ 6LQFH DVLJQL¿FDQWUHGXFWLRQ in mortality from prostate cancer has been observed in the Tyrol. In the years 2003 - 2005 prostate cancer mortality rates decreased by 48%, 55%, and 52%, respectively. &21&/86,216 7KHVH¿QGLQJVFRQ¿UPWKHK\SRWKHVLVWKDW freely available PSA testing, which has met with wide acceptance in the population, is associated with a reduction in prostate cancer mortality in an area where effective treatment is freely available to all men. It is likely that much of this decline in mortality rates is due to earlier detection and successful treatment of prostate cancer. However, and important FRUROODU\LPSOLFDWLRQRIRXUVWXG\LVWKDWVFUHHQLQJLVRQO\WKH¿UVWVWHS in the optimal management of prostate cancer. Source of Funding: None
1750 MASS SCREENING FOR PROSTATE CANCER IN KOREA: POPULATION-BASED STUDY Cheryn Song*, Hanjong Ahn, Taekyun Kwon, Hyung-Jin Kim, Jong Yeon Park, Han-Yong Choi. Seoul, Republic of Korea, Daegu, Republic of Korea, Jeonju, Republic of Korea, and Gangneung, Republic of Korea. INTRODUCTION AND OBJECTIVE: Lowest incidence of prostate cancer in the Asian population as well as in Korea compared to the Caucasians has repeatedly been reported. However, lack of data from a systematic screening system may have impeded proper comparison and assessment. We investigated prevalence of prostate cancer in Korean men through population-based mass screening test. METHODS: In June 2007, serum PSA was examined in residents in Gangneung, Daegu and Jeonju areas aged 55 years RU ROGHU DQG 36$ QJPO ZDV VHW IRU VLWH WUDQVUHFWDO ELRSV\ recommendation. Numbers of participants were 1430 from Gangneung, 1396 from Daegu, and 1117 from Jeonju areas summing up to 3943 in WRWDO6HUXP36$GLVWULEXWLRQDQGFDQFHUGHWHFWLRQUDWHVZHUHDQDO\]HG according to the regions and age groups of the participants (55-64, 65-74, 75-84, over 85 years). RESULTS: Serum PSA of the entire cohort was 2.4±8.6 ng/ POVLJQL¿FDQWO\LQFUHDVLQJZLWKWKHLQFUHDVHRIDJH ng/ml for respective age groups, p<0.0001) but no regional differences were noted (2.2, 2.7, 2.3 ng/ml for Gangneung, Daegu, and Jeonju respectively, p=0.290). Biopsy candidates were 6.0%(40) of the 55-year age group, 16.5%(367) of the 65-year age group, 25.3%(238) of the 75-year age group, and 34.5%(38) of the 85-year age group constituting 18.3%(721) of the entire cohort. Of the biopsy candidates, 268(37.2%) had undergone biopsy and cancer was detected in 76(28.4%) of the biopsied participants rendering cancer detection and estimated cancer detection rates 1.93% and 5.17%, respectively. Age-adjusted HVWLPDWHG FDQFHU GHWHFWLRQ UDWH \HDUV ZDV &DQFHU GHWHFWLRQ LQFUHDVHG VLJQL¿FDQWO\ ZLWK WKH LQFUHDVH LQ 36$ DW 3.0-4.0ng/ml, 28.1% at 4.1-10.0ng/ml, 73.6% at >10.0ng/ml) and mean 36$ZDVVLJQL¿FDQWO\KLJKHULQWKHFDQFHUGHWHFWHG YVQJPO p<0.0001). Gleason score was 2-6 in 39(53.4%), 7 in 14(19.2%) and 8-10 in 20(27.4%). Mean Gleason score was 6.9 and no correlation with serum PSA was found. CONCLUSIONS: In the present population-based prostate cancer screening, estimated cancer detection rate in Korean men DJHG \HDUV RU ROGHU ZDV ZKLFK LV VLJQL¿FDQWO\ KLJKHU WKDQ UHSRUWVIURPRWKHU$VLDQFRXQWULHV6LJQL¿FDQFHRIWKHKLJKUDWHLQWKLV population should be determined through repeated screening and further surveillance in the future. Source of Funding:$VWUD=HQHFD.RUHD
Vol. 179, No. 4, Supplement, Wednesday, May 21, 2008
1751 PROSTATE SPECIFIC ANTIGEN TESTING AMONG THE ELDERLY: WHEN TO STOP? H Ballentine Carter, Anna E Kettermann*, Luigi Ferrucci, Patricia Landis, Bruce J Trock, E Jeffrey Metter. Baltimore, MD. ,1752'8&7,21$1'2%-(&7,9( 3URVWDWHVSHFL¿FDQWLJHQ (PSA) testing for prostate cancer is common in the elderly, but the value of continued screening in older men is unclear. We determined the proportion of men who developed aggressive prostate cancer by PSA and age to evaluate the safety of discontinuing PSA testing among older men. METHODS: The probability of aggressive prostate cancer (death from prostate cancer) by PSA and age was determined from a cohort of 849 men (122 with and 727 without prostate cancer) who were participating in the Baltimore Longitudinal Study of Aging (National Institute on Aging). Fisher’s exact test was used for comparisons between groups of men by age and PSA. RESULTS: Subjects with a PSA of 3.0ng/ml and above at the age of 75-80 years had a probability of death from prostate cancer DIWHUZDUGVWKDWFRQWLQXHGWRLQFUHDVH ZKHUHDVQRVXEMHFWDWWKHDJH of 75-80 years with a PSA below 3.0ng/ml died of prostate cancer afterwards (P<.001, Fisher’s exact test). These results were similar ZKHQDJJUHVVLYHSURVWDWHFDQFHUZDVGH¿QHGDVGHDWKIURPSURVWDWH cancer, or Gleason score 8 or above at diagnosis, or PSA 20ng/ml or above at diagnosis. CONCLUSIONS: Men who have a PSA level below 3ng/ml at age 75-80 years are unlikely to develop aggressive prostate cancer during their remaining life and for these men PSA testing might be safely discontinued. Source of Funding: Intramural Research Program of the NIH, National Institute on Aging.
1752 DECLARING A MORATORIUM ON REPEAT BIOPSIES: A NEW STATISTICAL METHOD FOR PREDICTING WHEN REPEAT PROSTATE BIOPSIES ARE UNNECESSARY Angela J Fought, Edward F Vonesh, Lee C Zhao*, Dae Y Kim, William J Catalona, Peter H Gann. Chicago, IL. INTRODUCTION AND OBJECTIVE: Patients with persistently elevated PSA and/or abnormal DRE with previous negative biopsies IDFH D GLI¿FXOW FRQXQGUXP DERXW KRZ PDQ\ ELRSV\ SURFHGXUHV DUH needed to rule out prostate cancer and at what time intervals they should be performed. In this study, we use a new statistical model for time-dependent covariates to quantify the risk for and time to subsequent prostate cancer diagnosis in men with previous negative prostate biopsies. METHODS: From 1991 to 2002, a total of 1,871 men were screened for prostate cancer for over 5 years, with 465 diagnosed with SURVWDWH FDQFHU :H DQDO\]HG WKLV FRKRUW LQ D SLHFHZLVH H[SRQHQWLDO survival analysis using covariates of age, race, any chronic urinary symptoms, TRUS volume (transrectal ultrasound of prostate in cc), PSA SURVWDWHVSHFL¿FDQWLJHQ 36$VORSHWLPHSULRUWR¿UVWELRSV\QXPEHU of biopsy cores obtained, number of repeat biopsies, atypical acinar proliferation (“atypia”) or high-grade prostatic intraepithelial neoplasia ³3,1´ RQWKH¿UVWELRSV\FKURQLFSURVWDWLWLVGLJLWDOUHFWDOH[DP '5( ¿QGLQJV VXVSLFLRXV IRU FDQFHU DQG '5( ¿QGLQJV DEQRUPDO EXW QRW suspicious for cancer. 5(68/76 7KH KD]DUG UDWLR HVWLPDWH XVLQJ WKH SLHFHZLVH exponential model with covariates equal 0.36 ± 0.17 (0.15-0.90 95% FRQ¿GHQFHLQWHUYDO IRUJUHDWHUWKDQUHSHDWELRSVLHVYHUVXVELRSVLHV Thus, after 3 negative biopsies, the model predicts the likelihood of having prostate cancer detected in future biopsies as low. A survival curve generated in Figure 1 displays the age-adjusted survival for patients with 2, 3, and greater than 3 repeat biopsies with subsets of varying PSA levels. CONCLUSIONS: In this study, using a piecewise exponential model, there is a clear association of decreased prostate cancer risk and increased survival with greater than 3 negative biopsies. This new statistical model may be useful to aid patients and physicians in determining the need for repeat biopsies.