Prostate Cancer Screening with PSA: Ten Years' Experience of Population Based Early Prostate Cancer Detection Programme in Lithuania.

Ausvydas Patasius,Agne Krilaviciute,Giedre Smailyte

doi:10.3390/jcm9123826

Abstract

The aim of this study is to report key performance estimates from the ten years of a population-based prostate cancer screening programme in Lithuania. Retrospective analysis of screening activities recorded in 2006–2015 among men aged 50–74 years was performed. We estimated screening coverage, cancer detection rate, compliance to biopsy, and positive predictive values in each screening round inside and outside the target population. In the first 10 years of screening, 16,061 prostate cancer cases were registered within the screening programme, 10,202 were observed among screened men but reported outside the screening programme, and 1455 prostate cancers were observed in a screening-naïve population. Screening cover reached up to 45.5% of the target population in the recent rounds. The proportion of prostate specific antigen (PSA) test-positive men decreased from 16.9% in 2006 to 10.7% in 2014–2015. Up to 40.0% of PSA test-positive men received a biopsy, of whom 42.0% were positive for prostate cancer. The cancer detection rate was 10.4−15.0% among PSA test-positives and 1.4–1.9% among screened individuals. Screening participants were more likely to be diagnosed with organ-confined disease as compared to non-participants. Despite the unorganized screening practices being employed and low coverage per screening round, 70% of the target population were screened at least once in the first 10 years of screening.

Highlights

Prostate cancer is the third most common cancer in men [1] and the widespread implementation of prostate specific antigen (PSA) testing has changed the epidemiologic situation of prostate cancer worldwide [2]
Screening practices using PSA are ongoing in many countries, the benefits of such screening remain debated across communities [3]
The same indicators were calculated among men 45–49 years except from screening registered within the screening programme and 10,202 (38.2%) prostate cancers were observed among men who participated in the screening programme at least once, prostate cancer was not registered within the program

Summary

Introduction

Prostate cancer is the third most common cancer in men [1] and the widespread implementation of prostate specific antigen (PSA) testing has changed the epidemiologic situation of prostate cancer worldwide [2]. Leading to overdiagnosis and overtreatment, PSA-based screening has reduced prostate cancer mortality. Screening practices using PSA are ongoing in many countries, the benefits of such screening remain debated across communities [3]. The United States Preventive Service Task Force (USPSTF) recommended against prostate cancer screening in all age groups [4]. The United States discontinued prostate cancer screening in the same year, but this recommendation was updated in 2018, when it was recommended to screen 55–59-year old men based on a shared decision between the patient and physician [5]. The European Urology Association expressed their interest for PSA-based prostate cancer screening at the population level in European countries [6]. Appropriate screening measures to avoid overdiagnosis and overtreatment are yet to be determined

Objectives

Methods

Findings

Conclusion