Risk-adapted prostate cancer screening-update 2021

Abstract

Prostate cancer (PCa) is the most common cancer and the second leading cause of cancer death in men in industrialized countries. There is no commonly accepted prostate cancer screening strategy. Based on the experience of various international screening studies, the German Prostate Cancer Early Detection Study Based on aBaseline PSA Value in Young Men (PROBASE) was established in 2014. Based on the positive results of retrospective cohort analyses, the PROBASE study is designed to demonstrate that ascreening strategy based on risk stratification by abaseline prostate-specific antigen (PSA) level at age 45 or 50years may be an alternative to population-based screening. PROBASE is presented in the context of other risk-adapted screening studies. There are basically several approaches to improve the population-based screening of PCa. Known risk factors for prostate cancer are age, acertain genetic predisposition (BRCA1/2) and other germline mutations as well as individual somatic mutations. Atotal of 23,301 participants were randomized to study armA. Baseline PSA testing in study armA categorized 89.18% of participants into the low-risk group, 9.32% into the intermediate-risk group, and 1.48% into the high-risk group. Thus, the risk assignment exactly matched the previously reported distribution. Baseline PSA-dependent, risk-adapted PSA screening has the potential to reduce the high incidence of overdiagnosis and ultimately overtreatment of insignificant prostate cancers of population-based screening through extended testing intervals in the low-risk group. In parallel with PROBASE, several risk-adapted screening strategies are currently being tested worldwide; the evaluation of which is also awaited in several years.