You have accessJournal of UrologyProstate Cancer: Detection & Screening (III)1 Apr 20131934 PROSTATE SPECIFIC ANTIGEN (PSA)-PYRAMID IN MEN WITH LOW RANGE PSA: PROSTATE CANCER INCIDENCE AND MORTALITY - A PLEA FOR RISK-BASED PROSTATE CANCER SCREENING STRATEGY IN THE EUROPEAN RANDOMIZED STUDY OF SCREENING FOR PROSTATE CANCER (ERSPC), AARAU Marco Randazzo, Daniel Seiler, Josef Beatrice, Martin Baumgartner, Andreas Huber, Rainer Grobholz, Lukas Manka, Sascha Ahyai, Felix Chun, Franz Recker, and Maciej Kwiatkowski Marco RandazzoMarco Randazzo Aarau, Switzerland More articles by this author , Daniel SeilerDaniel Seiler Aarau, Switzerland More articles by this author , Josef BeatriceJosef Beatrice Aarau, Switzerland More articles by this author , Martin BaumgartnerMartin Baumgartner Aarau, Switzerland More articles by this author , Andreas HuberAndreas Huber Aarau, Switzerland More articles by this author , Rainer GrobholzRainer Grobholz Aarau, Switzerland More articles by this author , Lukas MankaLukas Manka Braunschweig, Germany More articles by this author , Sascha AhyaiSascha Ahyai Hamburg, Germany More articles by this author , Felix ChunFelix Chun Hamburg, Germany More articles by this author , Franz ReckerFranz Recker Aarau, Switzerland More articles by this author , and Maciej KwiatkowskiMaciej Kwiatkowski Aarau, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2353AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The ERSPC indicates prostate biopsy at the PSA cut-off value > 3.0 ng/ml. All men with a PSA below 3ng/ml at baseline are reinvited 4 years later. Whether this somewhat arbitrary interval adequately reflects the natural history of PCa is under scientific scrutiny at the moment. The current study describes the outcome of men who had an initial PSA <= 3.0 ng/ml in the Swiss section of the ERSPC cohort. METHODS Our study cohort consisted of n=4332 men (55-70 years of age). Re-screening took place every 4 years. In case of PSA-values > 3ng/ml, prostate biopsies were recommended. PCa cases were identified at rescreens every 4 years (screen detected PCa) or as interval cancers (through opportunistic PSA testing), which were detected through linkage with the pathology cancer registry. RESULTS The PSA-distribution at baseline was as follows: n=587 (13.6%) ranged between 2 to 2.99ng/ml, n=1437 (33.2%)from 1 to 1.99ng/ml and n=2308 (53.3%) from 0 to 0.99ng/ml, respectively. Overall, n=342 PCa cases were identified in the study cohort (median follow-up 10.2 years). In the 8-year period after the initial screening (comprising three screening rounds), the PCa rate including interval cancers of the very low PSA-group (0-0.99ng/ml) was 1.6% (n=36). If only PCa with a Gleason Score (GS) higher than 3+3=6 were counted, the rate was 0.69% (n=16 for GS >= 3+4) and 0.30% (n=7 for GS >= 4+3), respectively. In the 1–1.99 group, during 4 years (comprising two screening rounds), 59 PCa were diagnosed including interval cancers (4.1%). Of those, only n=12 (0.83%) had a GS of >=3+4 and n=5 (0.34%) had a GS of >= 4+3. Men with an initial PSA between 2.0-2.99ng/ml were found to have a clearly higher PCa rate during 4 years of n=89 (15.1%) of which 19 (3.2%) had a GS of >= 3+4 and 7 (1.2%) with a GS of > 4+3. With increasing PSA ranges, only 2 (0.09%), 4 (0.28%) and 2 (0.17%) men, respectively, died from PCa. CONCLUSIONS The incidence of clinically relevant PCa (defined by GS) and PCa specific mortality was very low during the follow-up of 10.2 years. We therefore suggest a “PSA- pyramid” with re-test intervals of 6-8 years at pyramid basis (0-0.99ng/ml). At center part (1.0-1.99ng/ml), a re-test should be done after 3-4 years. Men at the top level (2–2.99 ng/ml) are considered to undergo PSA testing 1–2 years. PSA-pyramid could serve as an efficient gate-keeper reassuring most of men for long time period and allowing to decrease substantially the number of PSA tests. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e793 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Randazzo Aarau, Switzerland More articles by this author Daniel Seiler Aarau, Switzerland More articles by this author Josef Beatrice Aarau, Switzerland More articles by this author Martin Baumgartner Aarau, Switzerland More articles by this author Andreas Huber Aarau, Switzerland More articles by this author Rainer Grobholz Aarau, Switzerland More articles by this author Lukas Manka Braunschweig, Germany More articles by this author Sascha Ahyai Hamburg, Germany More articles by this author Felix Chun Hamburg, Germany More articles by this author Franz Recker Aarau, Switzerland More articles by this author Maciej Kwiatkowski Aarau, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...