Is additional testing necessary in men with prostate-specific antigen levels of 1.0 ng/mL or less in a population-based screening setting? (ERSPC, section Rotterdam).
OBJECTIVE
Currently, several prostate cancer rescreening intervals are in use in different countries worldwide, varying from 1 to 4 years. Recently, it has been proposed to determine the rescreening interval relative to the initial prostate-specific antigen (PSA) level and possibly to extend the rescreening interval up to 5 years.


METHODS
We evaluated the screening results of two subsequent screening visits (4-year interval) of 1703 men aged 55 to 65 years with an initial PSA level of 1.0 ng/mL or less within a randomized screening trial. We assessed the PSA values, numbers of men biopsied (biopsy indication: PSA level of 3.0 ng/mL or greater), and numbers of cancers detected at the second and third screening visits.


RESULTS
A total of 1327 men (79.3%) attended the second screening visit. Of these men, 13 (0.98%) had a PSA level of 3.0 ng/mL or greater, and three cancers were detected (cancer detection rate 0.23%). At the third screening visit, 1017 men (76.8%) attended, 34 men (3.3%) had a PSA level of 3.0 ng/mL or greater, and five cancers were detected (cancer detection rate 0.49%). The 2344 subsequent PSA determinations in an 8-year period after the initial screening resulted in eight cancers detected, for an overall cancer detection rate of 0.47%. Through linkage of all men with the cancer registry, no additional cancers were found.


CONCLUSIONS
A strategy of PSA screening every 8 years for men with a PSA level of 1.0 ng/mL or less will lead to a considerable decrease in the number of screening visits (with the associated costs and stress), with a minimal risk of missing aggressive cancer at a curable stage.
Roobol
Monique J
MJ
Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands. m.roobol@erasmusmc.nl
Roobol
Dina W
DW
Schröder
Fritz H
FH
D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D015331:Cohort Studies; D042241:Early Diagnosis; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors; D019564:Unnecessary Procedures
D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D017430:Prostate-Specific Antigen