title: Detection of prostate cancer in unselected young men: prospective cohort nested within a randomised controlled trial.
abstract: OBJECTIVE
  To investigate the feasibility of testing for prostate cancer and the prevalence and characteristics of the disease in unselected young men.
  
  
  METHODS
  Prospective cohort nested within a randomised controlled trial, with two years of follow-up.
  
  
  METHODS
  Eight general practices in a UK city.
  
  
  METHODS
  1299 unselected men aged 45-49.
  
  
  METHODS
  Prostate biopsies for participants with a prostate specific antigen level of 1.5 ng/ml or more and the possibility of randomisation to three treatments for those with localised prostate cancer.
  
  
  METHODS
  Uptake of testing for prostate specific antigen; positive predictive value of prostate specific antigen; and prevalence of prostate cancer, TNM disease stage, and histological grade (Gleason score).
  
  
  RESULTS
  442 of 1299 men agreed to be tested for prostate specific antigen (34%) and 54 (12%) had a raised level. The positive predictive value for prostate specific antigen was 21.3%. Ten cases of prostate cancer were detected (2.3%) with eight having at least two positive results in biopsy cores and three showing perineural invasion. One tumour was of high volume (cT2c), Gleason score 7, with a positive result on digital rectal examination; nine tumours were cT1c, Gleason score 6, and eight had a negative result on digital rectal examination. Five of the nine eligible participants (55%) agreed to be randomised. No biochemical disease progression in the form of a rising prostate specific antigen level occurred in two years of follow-up.
  
  
  CONCLUSIONS
  Men younger than 50 will accept testing for prostate cancer but at a much lower rate than older men. Using an age based threshold of 1.5 ng/ml, the prevalence of prostate cancer was similar to that in older men (3.0 ng/ml threshold) and some cancers of potential clinical significance were found.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN20141297.
authors.affiliation: Department of Social Medicine, University of Bristol.
authors.forename: J Athene
authors.initials: JA
authors.lastname: Lane
authors.forename: Joanne
authors.initials: J
authors.lastname: Howson
authors.forename: Jenny L
authors.initials: JL
authors.lastname: Donovan
authors.forename: John R
authors.initials: JR
authors.lastname: Goepel
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Dedman
authors.forename: Liz
authors.initials: L
authors.lastname: Down
authors.forename: Emma L
authors.initials: EL
authors.lastname: Turner
authors.forename: David E
authors.initials: DE
authors.lastname: Neal
authors.forename: Freddie C
authors.initials: FC
authors.lastname: Hamdy
mesh_terms: D000367:Age Factors; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D015331:Cohort Studies; D051517:Digital Rectal Examination / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D016032:Randomized Controlled Trials as Topic
chemical_list: D017430:Prostate-Specific Antigen