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| References
–
Prostate-screening,
benign enlargement and cancer |
4.
Beemsterboer PM, Kranse R, De KH, Habbema JF, Schroder
FH. Changing role of 3 screening modalities
in the European randomized study of screening for
prostate cancer (Rotterdam). International Journal
of Cancer Vol 84.(4.) (pp.437.-441.), 1999.
Abstract: A randomized screening trial was started
in Europe to show the effect of early detection and
treatment of prostate cancer on mortality (European
Study on Screening of Prostate Cancer). In one centre
(Rotterdam), the screening protocol initially consisted
of 3 screening tests for all men: prostate- specific
antigen (PSA), digital rectal examination (DRE) and
transrectal ultrasonography (TRUS). A PSA value of
>=4 ng/ml and/or an abnormality on DRE and/or TRUS
were taken to indicate that biopsy was required. In
this study, we examined the possibilities for a more
efficient screening protocol. A logistic-regression
model was used to predict the number of cancers for
PSA < 4 ng/ml if all men were biopsied (predictive
index, PI). Effects of a change in PSA cut-off on
the screening results were explored. Weights were
applied to procedures and cancers to explore the possibility
of expressing differences between protocols in one
overall figure. Biopsies in men with PSA < 1 ng/ml
and a positive DRE or TRUS were very inefficient.
Applying DRE and TRUS only in the PSA ranges 1.5 to
3.9 and 2 to 3.9 ng/ml to determine whether a biopsy
was required would result in a decrease of 29 to 36%
in biopsies and a decrease of 5 to 8% in cancers.
However, the results of DRE and TRUS could not be
duplicated entirely. A protocol with only PSA >=
3 ng/ml as a direct biopsy indicator resulted in a
decrease of detected cancers by 7.6% and of biopsies
by 12%, also a much simpler screening procedure. Use
of the PI would give more efficient protocols, but
this should be viewed as a preliminary finding, with
the disadvantage of necessitating many additional
screening visits. Since the results of DRE and TRUS
could not be duplicated, a change in protocol towards
PSA >= 3 ng/ml appears acceptable. If this proves
effective, a final judgement about the optimal combination
of screening tests may be made. [References: 14] |
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