Prostate biopsy following a positive screen in the prostate, lung, colorectal and ovarian cancer screening trial.
OBJECTIVE
The benefit of prostate specific antigen (PSA) and digital rectal examination (DRE) screening for prostate cancer is under evaluation in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Followup of positive screens in PLCO is done by subject personal physicians and it is outside of trial control. We describe the pattern of prostate biopsy in men with positive screens in PLCO.


METHODS
We examined all men with positive baseline PSA or DRE screens and men with positive post-baseline screens occurring by December 2000.


RESULTS
Of 2,717 men with positive PSA (greater than 4 ng/ml) at baseline 41% and 64% underwent biopsy within 1 and 3 years, respectively. A screening PSA of 7 to 10 and greater than 10 ng/ml at baseline was associated with significantly higher biopsy rates (HR 1.9 and 2.6, respectively) compared to PSA 4 to 7 ng/ml. The 1,793 in men whom the first positive PSA was after baseline had a lower overall biopsy rate (50% within 3 years). Furthermore, PSA above 7 ng/ml were not associated with higher biopsy rates in this group. The 4,449 men with positive DRE screens and negative PSA had a 3-year biopsy rate of 27%. Men with positive DRE at diagnostic followup had a biopsy rate of around 90%. However, few men, even of those with positive DRE screens, had positive diagnostic DREs.


CONCLUSIONS
: These biopsy rates following positive PSA and DRE screens are likely to be representative of national rates. These results suggest that PLCO is evaluating the effects of screening in a contemporary and robust manner.
Pinsky
Paul F
PF
Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA. pinskyp@mail.nih.gov
Andriole
Gerald L
GL
Kramer
Barnett S
BS
Hayes
Richard B
RB
Prorok
Philip C
PC
Gohagan
John K
JK
D000368:Aged; D001706:Biopsy; D015179:Colorectal Neoplasms / Q000175:diagnosis; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000453:epidemiology / Q000473:pathology*; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis
D017430:Prostate-Specific Antigen