PD46-03 PROSTATE CANCER DETECTION AFTER THREE NEGATIVE SCREENS WITH A 4-YEAR INTERVAL. ERSPC ROTTERDAM

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening V1 Apr 2015PD46-03 PROSTATE CANCER DETECTION AFTER THREE NEGATIVE SCREENS WITH A 4-YEAR INTERVAL. ERSPC ROTTERDAM Monique Roobol, Daan Nieboer, and ERSPC study group Rotterdam Monique RoobolMonique Roobol More articles by this author , Daan NieboerDaan Nieboer More articles by this author , and ERSPC study group RotterdamERSPC study group Rotterdam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2734AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Whether or not repeated PSA based screening has an effect on reduction of advanced disease/PC mortality or merely contributes to over diagnosis is still unclear. In ERSPC Rotterdam men (55 to 74 yrs)are screened with a 4-year interval. Depending age at 1st screen 5 screens are possible. Here we report on cancer detection rate (CDR), tumor characteristics and screening history of/before 4th screening round (S-round, i.e. 12 years after 1st screening and completed 3 previous screens) and assess the possibility of selective detection of potentially aggressive PC. METHODS So far 3,253 men completed 4th screening (80%). A PSA >= 3.0 ng/ml triggered sextant biopsy (Bx). PC detected were subdivided according to d'Amico classification. Baseline age and PSA, PSA and PSA density at 4th S-round and PSA velocity ((PSA-V) from 0 – 4, 0-8 and 0-12 yr) and the risk count ( # intervals that PSA-V > 0.4 ng/ml/yr) were related to PC detection at 4th screening. RESULTS Median age at 4th screening was 70.3 (67.0-75). Eligible for Bx were 666 men (20.5%) and 566 men had a Bx (85%), 59% had a previous negative Bx. A total of 133 PC cases were detected (PPV = 133/566 = 23.5% and CDR = 133/3252 = 4.1%). 107 men (80.5%) had low, 15 (11.3%) intermediate and 11 (8.3%) high risk PC (table). PSA-density and having had a previous negative Bx were significant predictors in a multivariable regression analysis (including age at 4th screening and PSA-V4) with outcome noPC+low risk PC vs. intermediate + high risk PC (AUC 0.811). At 92% sensitivity (but including all high risk PC) 221 Bx could be avoided (39%) including the diagnosis of 24 low risk PC. Risk count did not have any added value in this screening setting. CONCLUSIONS After 3 previous S-rounds, each with an interval of 4 yr, overall PPV and CDR at 4th screening are comparable to earlier S-rounds. Most PC detected are however low risk and, considering the age of men, potentially over diagnosed. However, taking into account a life expectancy of at least 10 years selective detection of potentially aggressive PC is still warranted. Especially in a repeat screening setting a multivariate risk assessment including PSA density and previous Bx status should be used in the decision to biopsy in order to avoid unnecessary testing and potential over diagnosis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e957 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Monique Roobol More articles by this author Daan Nieboer More articles by this author ERSPC study group Rotterdam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...