title: The role of PSA in secondary screening of the same population.
abstract: This presentation addresses the value of PSA in populations of men that have already been screened, using PSA with an arbitrary cut-off point as a biopsy indication (data from the European Randomised Study of Screening for Prostate Cancer ERSPC, section Rotterdam). The positive predictive value of PSA, i.e., the percentage of men who have a positive biopsy at various PSA cut-off values, has been shown to be different in initial screens and secondary screens 4 years later by Raaijmakers et al. in 2003, using a PSA cut-off of 3 as a biopsy indication in first-round screening, The data refer to 1,850 men biopsied initially and 1,040 biopsied at repeat screening. The possible predictors of a positive biopsy in second-round screening were analysed using multivariate regression analysis. The most important positive predictors were 2-Log PSA, a positive rectal examination or transrectal ultrasonography, age, and a positive family history. The predictive value of PSA changes in pre-screened populations. PSA progression to an arbitrary cut-off of 3 or 4 ng/mL remained important and indicated a positive biopsy rate between 20 and 25% in second-round screening. PSAV is not a diagnostic marker in a screening setting. It may be a marker of cancer aggressiveness. For the time being, the use of arbitrary PSA cut-off values remains an important option for daily clinical practice. Common sense has to prevail until more valid information has become available for proper indications of biopsies in pre-screened populations.
authors.affiliation: Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. e.vandenberg@erasmusmc.nl
authors.forename: Fritz H
authors.initials: FH
authors.lastname: Schröder
mesh_terms: D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis*
chemical_list: D017430:Prostate-Specific Antigen