UROLOGICAL ONCOLOGY

Relationship between initial prostate specific antigen level and subsequent prostate cancer detection in a longitudinal screening study
Antenor JA, Han M, Roehl KA, Nadler RB, Catalona WJ
Departments of Neurology, Washington University, School of Medicine, St. Louis, Missouri, USA
J Urol. 2004; 172: 90-3

• Purpose: Previous studies of archived blood samples from nonscreened populations have shown an association between the prostate specific antigen (PSA) and the subsequent detection of prostate cancer. In the current study we evaluated the relationship between the initial screening PSA and the subsequent risk of prostate cancer detected in a prospective, longitudinal screening study. We also examined the relationship between initial PSA and the clinicopathological features of the cancers detected.
• Materials and Methods: Between May 1991 and November 2001 we enrolled 26,111 volunteers in our PSA and digital rectal examination based prostate cancer screening study. The men were followed biannually or annually depending on the results of previous screening tests. The chi-square and Kruskal-Wallis tests were used to compare the clinical stage, pathological stage and Gleason score of subsequently detected prostate cancers as well as the time to cancer detection in different initial screening PSA strata.
• Results: The initial screening PSA stratum was strongly associated with the subsequent detection of prostate cancer as well as the clinicopathological stage and grade of the cancers detected.
• Conclusions: Even in the lower PSA ranges initial screening serum PSA can help identify men at increased risk for subsequent prostate cancer detected in a longitudinal screening study.
  
  
• Editorial Comment
  This paper is worthwhile reading for all urologists dealing with prostate cancer.
  In this screening study the risk of prostate cancer is estimated dependent on the initial PSA value. Only 1% of men with initial PSA less than 1.0 ng/ml were subsequently diagnosed with prostate cancer. In contrast, more than half of the men with initial PSA greater than 10 ng/ml were subsequently diagnosed with cancer. 77% of those with initial PSA between 2.6 and 4.0 had organ confined disease while 67% with initial PSA between 4.0 and 10.0 had organ confined disease ( p=0.005 ) Of the men with initial PSA between 2.6 and 4.0 ng/ml 42% eventually had PSA that increased above 4.0 ng/ml, while only 2% of those with initial PSA less than 1.0 ng/ml had PSA that increased above 4.0 ng/ml during follow up.
  The detailed tables show, that men with initial screening PSA between 2.0 and 3.0 had 14.9% relative risk of developing prostate cancer whereas men with PSA 3.0 and 4.0 had relative risk of 23.3%.
  All together these data support the notion, that close follow up of men with initial PSA of at last higher than 2.5 should considered.

Dr. Andreas Böhle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany