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SERUM PSA LEVELS, NUMBER OF PROSTATE BIOPSIES AND NUMBER AND CHARACTERISTICS OF PROSTATE CANCERS DETECTED IN THREE CONSECUTIVE SCREENING VISITS USING A PSA BASED BIOPSY INDICATION
513 SERUM PSA LEVELS, NUMBER OF PROSTATE BIOPSIES AND NUMBER AND CHARACTERISTICS OF PROSTATE CANCERS DETECTED IN THREE CONSECUTIVE SCREENING VISITS USING A PSA BASED BIOPSY INDICATION
514 SCREENING INTERVAL IN MEN WITH AN ABNORMAL DIGITAL RECTAL EXAMINATION IN A RANDOMISED STUDY OF SCREENING FOR PROSTATE CANCER
Roobol M.J., Van Den Bergh R.C.N., Wolters T., Gosselaar C., Bangma C.H., Schröder F.H.
Gosselaar C., Roobol M.J., Van Den Bergh, R.C.N., Wolters T., Schröder H., European Randomized Study of Screening for Prostate Cancer
Erasmus Medical Centre, Dept. of Urology, Rotterdam, The Netherlands
Erasmus MC, Dept. of Urology, Rotterdam, The Netherlands
Introduction & Objectives: The screening algorithm of the Dutch centre of the European Randomized study of Screening for prostate Cancer (ERSPC) originally (protocol 1) indicated a prostate biopsy for men with a PSA >= 4.0 ng/ml or an abnormal digital rectal examination (DRE) and/or abnormal transrectal ultrasound (TRUS). This was changed half way the initial screening round to a purely serum PSA level based indication IRUIXUWKHUWHVWLQJ SURWRFRO 0HQZLWKD36$! QJPODUHUHIHUUHGIRUD'5(D7586DQGDODWHUDOL]HG sextant biopsy. Here we evaluate the results of three consecutive screening rounds (4-year interval) of men aged 55-74 years at initial screening. Material & Methods: %HWZHHQ PHQ ZHUH UDQGRPL]HG WR VFUHHQLQJ men were screened. 9,779 men were screened according protocol 1 and 10,191 men according protocol $W UHSHDW PHQ DQG WKLUG VFUHHQLQJ PHQ DOO PHQ ZHUH VFUHHQHG according to protocol 2. We compared PSA distribution, percentage of men referred for biopsy, positive SUHGLFWLYHYDOXH 339 13&1PHQELRSVLHG DQGFDQFHUGHWHFWLRQUDWHV &'5 13&1PHQVFUHHQHG Next to this the percentage of T1C with Gleason scores <= 6 PC cases was assessed. At second and third screening (90% complete, all data available in Dec. 2007) men without and with one or two previous negative biopsy(ies) (Prevb) were separately evaluated. Results: 36$
36$!
biopsy
PC detected CDR
Screening round 1st N= 9,779 1st N=10,191 2nd N=12,529 3UHYE1 No Prevb N= 10,890 rd N= 6,684 3UHYE1 1 Prevb N= 1,162 1R3UHYE1
N(%) 8,510 (87)* 8,044 (79) 10,027 (80) 9,440 (87) 5,482 (80) 590 (51) 4,861 (90)
N, (%) 2,147 (21) 2,502 (20) 1,052 (64) 298 (91) 572 (49) 512 (10)
N 2,267** 1,850 2,217 1,264 1,215 267 514
N 541 441 116 241 80 122
% T1C , GS <= 6 of total PC detected PPV % 20.9 4.8 19.0 29.2 19.9 49.0 12.2 51.7 25.7 48.0 19.8 59.1 14.6 66.7 15.6 28.1 55.7
* N of men with PSA < or >= 4.0 ng/ml, ** including biopsies in men with PSA < 4.0 ng/ml Conclusions: 7KH339RID36$! QJPOGHFUHDVHVDWVXEVHTXHQWVFUHHQLQJ7KHPHQZKRKDGD Prevb mainly cause this decrease. The proportion of PC detected in men without a Prevb (i.e. reaching the 36$WKUHVKROGYDOXHIRUWKHᚏUVWWLPH UHPDLQVKLJKDWVXEVHTXHQWVFUHHQLQJURXQGVUHVXOWLQJLQDVLPLODU FDQFHUGHWHFWLRQUDWHDWWKHWZRUHSHDWVFUHHQLQJYLVLWV7KLVFRQᚏUPVWKHSUHVHQFHRIDFRQVLGHUDEOHQXPEHU of biopsy detectable PC cases at low PSA levels. At the same time the number of T1c GS <= 6 PC cases LQFUHDVHVDWUHSHDWVFUHHQLQJ'DWDLQGLFDWHDGHᚏQLWHQHHGWRLPSURYHVSHFLᚏFLW\LQERWKWKHELRSV\LQGLFDWLRQ as in detecting potentially life-threatening PC.
Introduction & Objectives: Within the European Randomized Study of Screening for 3URVWDWH &DQFHU (563& VHFWLRQ 5RWWHUGDP DOO PHQ ZLWK D 36$ OHYHO EHORZ WKH FXWRᚎ YDOXHIRUSURVWDWHELRSV\ LH36$ QJPO DQGPHQZLWKD36$! QJPODQGDEHQLJQ biopsy result are reinvited for a repeat screening 4 years later, regardless of PSA level and outcome of the digital rectal examination (DRE). Here we analyse whether men with an LQLWLDOO\DEQRUPDO'5(DQGDEHQLJQSURVWDWHELRSV\DUHDWKLJKHUULVNWRGHYHORSVLJQLᚏFDQW (clinical stage >T2a and Gleason score (GS) >=7) prostate cancer (PC) in the following years and if an adaptation of the rescreening interval is warranted in this group. Material & Methods: Our study population consisted of 2218 men biopsied at initial screening but no PC detected. We assessed the number and characteristics of PCs found at repeat screenings (after 4 and 8 years) and clinically detected PCs during the 2 intervals of 4 years (interval cancers (IC)). Distinction was made between men with a suspicious DRE result and men with normal DRE at time of initial biopsy. To assess the number of ICs, the total cohort of 2218 men was linked to the Cancer Registry. Results: At initial screening 462 (21%) men had a suspicious DRE result and 1756 (79%) men had a normal DRE. After 4 years, the total number of PCs detected in men with an LQLWLDOO\DEQRUPDO'5(DQGZLWKRXWZDV DPRQJZKLFK,&V DQG DPRQJ ZKLFK ,&V S &KLVTXDUH UHVSHFWLYHO\$IWHU\HDUVWKHVHQXPEHUVDPRXQWHGWR 45 (10%, among which 14 ICs) and 167 (10%, among which 50 ICs) (p=0.8841, Chi-square), UHVSHFWLYHO\ 7KUHH FOLQLFDOO\ VLJQLᚏFDQW 3&V DOO VFUHHQGHWHFWHG ZHUH GHWHFWHG LQ men with an initially abnormal DRE after 4 years in contrast to 7 (0.4%, of which 2 ICs) in men ZLWKDQRUPDO'5(DWᚏUVWVFUHHQ(LJKW\HDUVDIWHULQLWLDOVFUHHQLQJWKHVHQXPEHUVDPRXQWHG to 4 (0.9%, of which 1 IC) and 8 (0.5%, of which 2 ICs), respectively. Conclusions: 'XULQJ D IROORZXS SHULRG RI \HDUV DIWHU LQLWLDO VFUHHQLQJ QR VLJQLᚏFDQW GLᚎHUHQFHZDVIRXQGLQWKHWRWDOQXPEHURI3&GHWHFWHGLQERWKJURXSV7KHSURSRUWLRQRI ,&VZDVVLPLODULQERWKJURXSVDVZHOO7KHGHWHFWLRQUDWHRIFOLQLFDOO\VLJQLᚏFDQW3&LVORZ in men with a previous cancer-negative biopsy result. Comparison of tumor characteristics VKRZHG QR GLVWLQFW GLᚎHUHQFHV LQ WKH GHWHFWLRQ RI FOLQLFDOO\ VLJQLᚏFDQW GLVHDVH %DVHG RQ these observations we conclude that men with an initially abnormal DRE and a benign SURVWDWHELRSV\DUHQRWDWKLJKHUULVNWRGHYHORSFOLQLFDOO\VLJQLᚏFDQW3&DVFRPSDUHGWRPHQ with a normal DRE. An adaptation of the re-screening interval on the basis of DRE outcome is not warranted.
515
516
FALSE POSITIVE SCREENING RESULTS IN THE FINNISH PROSTATE CANCER SCREENING TRIAL
THE CAUSAL RELATIONSHIP BETWEEN METABOLIC SYNDROME AND PROSTATE-SPECIFIC ANTIGEN LEVEL
Kilpeläinen T.1, Tammela T.L.2, Martikainen P., Määttänen L.4, Auvinen A.1
Kim Y.J.1, Lee Y.S.2, Yun S.J.1, Lee S.C.1, Kim W.J.1 2
1
University of Tampere, Tampere School of Public Health, Tampere, Finland, University of Tampere, Dept. of Urology, Tampere, Finland, Tampere University Hospital, Dept. of Pathology, Tampere, Finland, 4Finnish Cancer Registry, Finnish Cancer Registry, Helsinki, Finland
Introduction & Objectives: Prostate cancer (PC) is the most common cancer among men in WKH LQGXVWULDOL]HG FRXQWULHV 6FUHHQLQJ IRU 3& ZLWK SURVWDWHVSHFLᚏF DQWLJHQ 36$ VHUXP WHVW LV becoming increasingly common despite high false positive rate and lack of evidence for a decrease in PC mortality. The purpose of our study was to investigate the proportion of false positives in a population-based randomised screening trial in Finland. Material & Methods: The European Randomised Study of Screening for Prostate Cancer (ERSPC) is a multicentre study with almost 200 000 men, the Finnish component being the largest with more than 80,000 men. In Finland three screening rounds have been carried out, with 20,796 men SDUWLFLSDWLQJLQWKHVWURXQGLQWKHQGDQG PHQUGURXQG QRW\HWFRPSOHWHG $W HDFKVFUHHQWKH36$OHYHOZDVGHWHUPLQHGZLWKDFXWRᚎOHYHORIQJPO,QDGGLWLRQPHQZLWK 36$ ZLWKIUHHWRWDOUDWLR ZHUHUHIHUUHG$IDOVHSRVLWLYHVFUHHQLQJUHVXOWZDVGHᚏQHG as diagnostic biopsy with no cancer found in the histological examination. Results: Round I II III
Screen-negative 18819 (90.5%) 8279 (89.2%)
False positive 704 (7.6%)
Prostate Cancer
Total 18526 (100%) 9285 (100%)
The proportion of false positive was 6-8% per round, with some increase at repeat screens. Of the 21,952 participants, 2507 (11.42%) men had a FP result at least once during the three rounds. The QXPEHURIPHQZKRSDUWLFLSDWHGLQDOOWKUHHURXQGVZDVDQGRIWKHP &, had at least one FP result. The risk for receiving a FP result after a previous round positive PSA test ZDVLQWKHQGURXQGDQGLQWKHUGURXQG7KHULVNIRUKDYLQJD)3UHVXOWDIWHUDQHJDWLYH 36$WHVWLQWKHSUHYLRXVURXQGZDVLQURXQGDQGLQURXQG7KHULVNUDWLRIRUPHQZLWK previous positive compared with negative screen was 10.59 (CI 9.68-11.59) in round 2 and 11.45 &, LQURXQG7KHULVNRISURVWDWHFDQFHUIROORZLQJD)3UHVXOWZDVLQWKHQG URXQGDQGLQWKHUGURXQG7KHFRUUHVSRQGLQJULVNVIRUVFUHHQQHJDWLYHPHQZHUHLQ URXQGDQGLQURXQG7KHULVNUDWLRVIRUPHQZLWK)3UHVXOWVZHUH &, LQWKH second and 5.81 (CI 4.44-7.62) in the third round. Conclusions: )3UHVXOWLVWKHPRVWFRPPRQDGYHUVHHᚎHFWRIVFUHHQLQJDQGDᚎHFWVDWOHDVWDWHQWK RIPHQVFUHHQHGUHSHDWHGO\HYHQZKHQXVLQJDUHODWLYHO\KLJKFXWRᚎOHYHO7KHUHLVDQLQFUHDVHG risk for both subsequent FP, as well as PC diagnosis after a FP result. Men with FP result constitute a special group in screening, as they receive unnecessary interventions, but may also harbour missed cancers. New strategies are needed to deal with this issue.
1 2
Chungbuk National University, Dept. of Urology, Cheongju, South Korea, Sungkyunkwan University, Dept. of Urology, Seoul, South Korea
Introduction & Objectives: 3URVWDWHVSHFLᚏF DQWLJHQ 36$ OHYHOV DUH DᚎHFWHG E\ PDQ\ IDFWRUV 0HWDEROLF V\QGURPH LV D FRPPRQ PHWDEROLF disorder related to increasing prevalence of obesity. However, the relationship between metabolic syndrome and PSA is currently unknown. 7KHDLPRIWKLVVWXG\ZDVWRH[DPLQHZKHWKHU36$OHYHOVZHUHDᚎHFWHGE\ metabolic syndrome. Material & Methods: We evaluated the association between metabolic V\QGURPHDQG36$LQDJURXSRIPHQ DJHGWR \HDUV ZLWKRXW prostate cancer who received a general health check-up. Metabolic V\QGURPHZDVGHᚏQHGDFFRUGLQJWRWKHPRGLᚏHG1&(3$73,,,JXLGHOLQHV (OLJLEOH PHQ ZHUH FODVVLᚏHG DFFRUGLQJ WR WKH QXPEHU RI HDFK FRPSRQHQW and the presence or absence of metabolic syndrome. Results: PSA levels, as a whole, were inversely correlated with metabolic V\QGURPH S ,QFUHDVLQJ QXPEHU RI PHWDEROLF FRPSRQHQWV ZDV VLJQLᚏFDQWO\DVVRFLDWHGZLWKOLQHDUGHFUHDVLQJWUHQGVRI36$OHYHOV SWUHQG < 0.001). When a multivariate analysis was performed with age and each PHWDEROLFFRPSRQHQWDJH ˟ S &, WR REHVLW\ ˟ S &, WR DQG LPSDLUHG IDVWLQJJOXFRVHOHYHO ˟ S &, WR ZHUH strongly associated with PSA levels. Conclusions: Our study demonstrates that metabolic syndrome is associated with decreased PSA levels. When determining whether to perform prostate biopsy as part of early prostate cancer detection, metabolic syndrome should be considered as a factor associated with reduced PSA in men presenting with marginal PSA levels.
Eur Urol Suppl 2008;7(3):199
514 SCREENING INTERVAL IN MEN WITH AN ABNORMAL DIGITAL RECTAL EXAMINATION IN A RANDOMISED STUDY OF SCREENING FOR PROSTATE CANCER
Roobol M.J., Van Den Bergh R.C.N., Wolters T., Gosselaar C., Bangma C.H., Schröder F.H.
Gosselaar C., Roobol M.J., Van Den Bergh, R.C.N., Wolters T., Schröder H., European Randomized Study of Screening for Prostate Cancer
Erasmus Medical Centre, Dept. of Urology, Rotterdam, The Netherlands
Erasmus MC, Dept. of Urology, Rotterdam, The Netherlands
Introduction & Objectives: The screening algorithm of the Dutch centre of the European Randomized study of Screening for prostate Cancer (ERSPC) originally (protocol 1) indicated a prostate biopsy for men with a PSA >= 4.0 ng/ml or an abnormal digital rectal examination (DRE) and/or abnormal transrectal ultrasound (TRUS). This was changed half way the initial screening round to a purely serum PSA level based indication IRUIXUWKHUWHVWLQJ SURWRFRO 0HQZLWKD36$! QJPODUHUHIHUUHGIRUD'5(D7586DQGDODWHUDOL]HG sextant biopsy. Here we evaluate the results of three consecutive screening rounds (4-year interval) of men aged 55-74 years at initial screening. Material & Methods: %HWZHHQ PHQ ZHUH UDQGRPL]HG WR VFUHHQLQJ men were screened. 9,779 men were screened according protocol 1 and 10,191 men according protocol $W UHSHDW PHQ DQG WKLUG VFUHHQLQJ PHQ DOO PHQ ZHUH VFUHHQHG according to protocol 2. We compared PSA distribution, percentage of men referred for biopsy, positive SUHGLFWLYHYDOXH 339 13&1PHQELRSVLHG DQGFDQFHUGHWHFWLRQUDWHV &'5 13&1PHQVFUHHQHG Next to this the percentage of T1C with Gleason scores <= 6 PC cases was assessed. At second and third screening (90% complete, all data available in Dec. 2007) men without and with one or two previous negative biopsy(ies) (Prevb) were separately evaluated. Results: 36$
36$!
biopsy
PC detected CDR
Screening round 1st N= 9,779 1st N=10,191 2nd N=12,529 3UHYE1 No Prevb N= 10,890 rd N= 6,684 3UHYE1 1 Prevb N= 1,162 1R3UHYE1
N(%) 8,510 (87)* 8,044 (79) 10,027 (80) 9,440 (87) 5,482 (80) 590 (51) 4,861 (90)
N, (%) 2,147 (21) 2,502 (20) 1,052 (64) 298 (91) 572 (49) 512 (10)
N 2,267** 1,850 2,217 1,264 1,215 267 514
N 541 441 116 241 80 122
% T1C , GS <= 6 of total PC detected PPV % 20.9 4.8 19.0 29.2 19.9 49.0 12.2 51.7 25.7 48.0 19.8 59.1 14.6 66.7 15.6 28.1 55.7
* N of men with PSA < or >= 4.0 ng/ml, ** including biopsies in men with PSA < 4.0 ng/ml Conclusions: 7KH339RID36$! QJPOGHFUHDVHVDWVXEVHTXHQWVFUHHQLQJ7KHPHQZKRKDGD Prevb mainly cause this decrease. The proportion of PC detected in men without a Prevb (i.e. reaching the 36$WKUHVKROGYDOXHIRUWKHᚏUVWWLPH UHPDLQVKLJKDWVXEVHTXHQWVFUHHQLQJURXQGVUHVXOWLQJLQDVLPLODU FDQFHUGHWHFWLRQUDWHDWWKHWZRUHSHDWVFUHHQLQJYLVLWV7KLVFRQᚏUPVWKHSUHVHQFHRIDFRQVLGHUDEOHQXPEHU of biopsy detectable PC cases at low PSA levels. At the same time the number of T1c GS <= 6 PC cases LQFUHDVHVDWUHSHDWVFUHHQLQJ'DWDLQGLFDWHDGHᚏQLWHQHHGWRLPSURYHVSHFLᚏFLW\LQERWKWKHELRSV\LQGLFDWLRQ as in detecting potentially life-threatening PC.
Introduction & Objectives: Within the European Randomized Study of Screening for 3URVWDWH &DQFHU (563& VHFWLRQ 5RWWHUGDP DOO PHQ ZLWK D 36$ OHYHO EHORZ WKH FXWRᚎ YDOXHIRUSURVWDWHELRSV\ LH36$ QJPO DQGPHQZLWKD36$! QJPODQGDEHQLJQ biopsy result are reinvited for a repeat screening 4 years later, regardless of PSA level and outcome of the digital rectal examination (DRE). Here we analyse whether men with an LQLWLDOO\DEQRUPDO'5(DQGDEHQLJQSURVWDWHELRSV\DUHDWKLJKHUULVNWRGHYHORSVLJQLᚏFDQW (clinical stage >T2a and Gleason score (GS) >=7) prostate cancer (PC) in the following years and if an adaptation of the rescreening interval is warranted in this group. Material & Methods: Our study population consisted of 2218 men biopsied at initial screening but no PC detected. We assessed the number and characteristics of PCs found at repeat screenings (after 4 and 8 years) and clinically detected PCs during the 2 intervals of 4 years (interval cancers (IC)). Distinction was made between men with a suspicious DRE result and men with normal DRE at time of initial biopsy. To assess the number of ICs, the total cohort of 2218 men was linked to the Cancer Registry. Results: At initial screening 462 (21%) men had a suspicious DRE result and 1756 (79%) men had a normal DRE. After 4 years, the total number of PCs detected in men with an LQLWLDOO\DEQRUPDO'5(DQGZLWKRXWZDV DPRQJZKLFK,&V DQG DPRQJ ZKLFK ,&V S &KLVTXDUH UHVSHFWLYHO\$IWHU\HDUVWKHVHQXPEHUVDPRXQWHGWR 45 (10%, among which 14 ICs) and 167 (10%, among which 50 ICs) (p=0.8841, Chi-square), UHVSHFWLYHO\ 7KUHH FOLQLFDOO\ VLJQLᚏFDQW 3&V DOO VFUHHQGHWHFWHG ZHUH GHWHFWHG LQ men with an initially abnormal DRE after 4 years in contrast to 7 (0.4%, of which 2 ICs) in men ZLWKDQRUPDO'5(DWᚏUVWVFUHHQ(LJKW\HDUVDIWHULQLWLDOVFUHHQLQJWKHVHQXPEHUVDPRXQWHG to 4 (0.9%, of which 1 IC) and 8 (0.5%, of which 2 ICs), respectively. Conclusions: 'XULQJ D IROORZXS SHULRG RI \HDUV DIWHU LQLWLDO VFUHHQLQJ QR VLJQLᚏFDQW GLᚎHUHQFHZDVIRXQGLQWKHWRWDOQXPEHURI3&GHWHFWHGLQERWKJURXSV7KHSURSRUWLRQRI ,&VZDVVLPLODULQERWKJURXSVDVZHOO7KHGHWHFWLRQUDWHRIFOLQLFDOO\VLJQLᚏFDQW3&LVORZ in men with a previous cancer-negative biopsy result. Comparison of tumor characteristics VKRZHG QR GLVWLQFW GLᚎHUHQFHV LQ WKH GHWHFWLRQ RI FOLQLFDOO\ VLJQLᚏFDQW GLVHDVH %DVHG RQ these observations we conclude that men with an initially abnormal DRE and a benign SURVWDWHELRSV\DUHQRWDWKLJKHUULVNWRGHYHORSFOLQLFDOO\VLJQLᚏFDQW3&DVFRPSDUHGWRPHQ with a normal DRE. An adaptation of the re-screening interval on the basis of DRE outcome is not warranted.
515
516
FALSE POSITIVE SCREENING RESULTS IN THE FINNISH PROSTATE CANCER SCREENING TRIAL
THE CAUSAL RELATIONSHIP BETWEEN METABOLIC SYNDROME AND PROSTATE-SPECIFIC ANTIGEN LEVEL
Kilpeläinen T.1, Tammela T.L.2, Martikainen P., Määttänen L.4, Auvinen A.1
Kim Y.J.1, Lee Y.S.2, Yun S.J.1, Lee S.C.1, Kim W.J.1 2
1
University of Tampere, Tampere School of Public Health, Tampere, Finland, University of Tampere, Dept. of Urology, Tampere, Finland, Tampere University Hospital, Dept. of Pathology, Tampere, Finland, 4Finnish Cancer Registry, Finnish Cancer Registry, Helsinki, Finland
Introduction & Objectives: Prostate cancer (PC) is the most common cancer among men in WKH LQGXVWULDOL]HG FRXQWULHV 6FUHHQLQJ IRU 3& ZLWK SURVWDWHVSHFLᚏF DQWLJHQ 36$ VHUXP WHVW LV becoming increasingly common despite high false positive rate and lack of evidence for a decrease in PC mortality. The purpose of our study was to investigate the proportion of false positives in a population-based randomised screening trial in Finland. Material & Methods: The European Randomised Study of Screening for Prostate Cancer (ERSPC) is a multicentre study with almost 200 000 men, the Finnish component being the largest with more than 80,000 men. In Finland three screening rounds have been carried out, with 20,796 men SDUWLFLSDWLQJLQWKHVWURXQGLQWKHQGDQG PHQUGURXQG QRW\HWFRPSOHWHG $W HDFKVFUHHQWKH36$OHYHOZDVGHWHUPLQHGZLWKDFXWRᚎOHYHORIQJPO,QDGGLWLRQPHQZLWK 36$ ZLWKIUHHWRWDOUDWLR ZHUHUHIHUUHG$IDOVHSRVLWLYHVFUHHQLQJUHVXOWZDVGHᚏQHG as diagnostic biopsy with no cancer found in the histological examination. Results: Round I II III
Screen-negative 18819 (90.5%) 8279 (89.2%)
False positive 704 (7.6%)
Prostate Cancer
Total 18526 (100%) 9285 (100%)
The proportion of false positive was 6-8% per round, with some increase at repeat screens. Of the 21,952 participants, 2507 (11.42%) men had a FP result at least once during the three rounds. The QXPEHURIPHQZKRSDUWLFLSDWHGLQDOOWKUHHURXQGVZDVDQGRIWKHP &, had at least one FP result. The risk for receiving a FP result after a previous round positive PSA test ZDVLQWKHQGURXQGDQGLQWKHUGURXQG7KHULVNIRUKDYLQJD)3UHVXOWDIWHUDQHJDWLYH 36$WHVWLQWKHSUHYLRXVURXQGZDVLQURXQGDQGLQURXQG7KHULVNUDWLRIRUPHQZLWK previous positive compared with negative screen was 10.59 (CI 9.68-11.59) in round 2 and 11.45 &, LQURXQG7KHULVNRISURVWDWHFDQFHUIROORZLQJD)3UHVXOWZDVLQWKHQG URXQGDQGLQWKHUGURXQG7KHFRUUHVSRQGLQJULVNVIRUVFUHHQQHJDWLYHPHQZHUHLQ URXQGDQGLQURXQG7KHULVNUDWLRVIRUPHQZLWK)3UHVXOWVZHUH &, LQWKH second and 5.81 (CI 4.44-7.62) in the third round. Conclusions: )3UHVXOWLVWKHPRVWFRPPRQDGYHUVHHᚎHFWRIVFUHHQLQJDQGDᚎHFWVDWOHDVWDWHQWK RIPHQVFUHHQHGUHSHDWHGO\HYHQZKHQXVLQJDUHODWLYHO\KLJKFXWRᚎOHYHO7KHUHLVDQLQFUHDVHG risk for both subsequent FP, as well as PC diagnosis after a FP result. Men with FP result constitute a special group in screening, as they receive unnecessary interventions, but may also harbour missed cancers. New strategies are needed to deal with this issue.
1 2
Chungbuk National University, Dept. of Urology, Cheongju, South Korea, Sungkyunkwan University, Dept. of Urology, Seoul, South Korea
Introduction & Objectives: 3URVWDWHVSHFLᚏF DQWLJHQ 36$ OHYHOV DUH DᚎHFWHG E\ PDQ\ IDFWRUV 0HWDEROLF V\QGURPH LV D FRPPRQ PHWDEROLF disorder related to increasing prevalence of obesity. However, the relationship between metabolic syndrome and PSA is currently unknown. 7KHDLPRIWKLVVWXG\ZDVWRH[DPLQHZKHWKHU36$OHYHOVZHUHDᚎHFWHGE\ metabolic syndrome. Material & Methods: We evaluated the association between metabolic V\QGURPHDQG36$LQDJURXSRIPHQ DJHGWR \HDUV ZLWKRXW prostate cancer who received a general health check-up. Metabolic V\QGURPHZDVGHᚏQHGDFFRUGLQJWRWKHPRGLᚏHG1&(3$73,,,JXLGHOLQHV (OLJLEOH PHQ ZHUH FODVVLᚏHG DFFRUGLQJ WR WKH QXPEHU RI HDFK FRPSRQHQW and the presence or absence of metabolic syndrome. Results: PSA levels, as a whole, were inversely correlated with metabolic V\QGURPH S ,QFUHDVLQJ QXPEHU RI PHWDEROLF FRPSRQHQWV ZDV VLJQLᚏFDQWO\DVVRFLDWHGZLWKOLQHDUGHFUHDVLQJWUHQGVRI36$OHYHOV SWUHQG < 0.001). When a multivariate analysis was performed with age and each PHWDEROLFFRPSRQHQWDJH ˟ S &, WR REHVLW\ ˟ S &, WR DQG LPSDLUHG IDVWLQJJOXFRVHOHYHO ˟ S &, WR ZHUH strongly associated with PSA levels. Conclusions: Our study demonstrates that metabolic syndrome is associated with decreased PSA levels. When determining whether to perform prostate biopsy as part of early prostate cancer detection, metabolic syndrome should be considered as a factor associated with reduced PSA in men presenting with marginal PSA levels.
Eur Urol Suppl 2008;7(3):199