title: The feasibility and results of a population-based approach to evaluating prostate-specific antigen screening for prostate cancer in men with a raised familial risk.
abstract: The feasibility of a population-based evaluation of screening for prostate cancer in men with a raised familial risk was investigated by studying reasons for non-participation and uptake rates according to postal recruitment and clinic contact. The levels of prostate-specific antigen (PSA) and the positive predictive values (PPV) for cancer in men referred with a raised PSA and in those biopsied were analysed. First-degree male relatives (FDRs) were identified through index cases (ICs): patients living in two regions of England and diagnosed with prostate cancer at age < or =65 years from 1998 to 2004. First-degree relatives were eligible if they were aged 45-69 years, living in the UK and had no prior diagnosis of prostate cancer. Postal recruitment was low (45 of 1687 ICs agreed to their FDR being contacted: 2.7%) but this was partly due to ICs not having eligible FDRs. A third of ICs in clinic had eligible FDRs and 49% (192 out of 389) agreed to their FDR(s) being contacted. Of 220 eligible FDRs who initially consented, 170 (77.3%) had a new PSA test taken and 32 (14.5%) provided a previous PSA result. Among the 170 PSA tests, 10% (17) were > or =4 ng ml(-1) and 13.5% (23) tests above the age-related cutoffs. In 21 men referred, five were diagnosed with prostate cancer (PPV 24%; 95% CI 8, 47). To study further the effects of screening, patients with a raised familial risk should be counselled in clinic about screening of relatives and data routinely recorded so that the effects of screening on high-risk groups can be studied.
authors.affiliation: Cancer Screening Evaluation Unit, Institute of Cancer Research, Brookes Lawley Building, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK. jane.melia@icr.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Melia
authors.forename: D
authors.initials: D
authors.lastname: Dearnaley
authors.forename: S
authors.initials: S
authors.lastname: Moss
authors.forename: L
authors.initials: L
authors.lastname: Johns
authors.forename: P
authors.initials: P
authors.lastname: Coulson
authors.forename: C
authors.initials: C
authors.lastname: Moynihan
authors.forename: J
authors.initials: J
authors.lastname: Sweetman
authors.forename: M C
authors.initials: MC
authors.lastname: Parkinson
authors.forename: R
authors.initials: R
authors.lastname: Eeles
authors.forename: M
authors.initials: M
authors.lastname: Watson
mesh_terms: D017668:Age of Onset; D000368:Aged; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D010375:Pedigree; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012016:Reference Values; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen