Individualized screening interval for prostate cancer based on prostate-specific antigen level: results of a prospective, randomized, population-based study.

BACKGROUND The aim of the present study was to evaluate the future cumulative risk of prostate cancer in relation to levels of prostate-specific antigen (PSA) in blood and to determine whether this information could be used to individualize the PSA testing interval. METHODS The study included 5855 of 9972 men (aged 50-66 years) who accepted an invitation to participate in a prospective, randomized study of early detection for prostate cancer. We used a protocol based on biennial PSA measurements starting from 1995 and 1996. Men with serum PSA levels of 3.0 ng/mL or more were offered prostate biopsies. RESULTS Among the 5855 men, 539 cases of prostate cancer (9.2%) were detected after a median follow-up of 7.6 years (up to July 1, 2003). Cancer detection rates during the follow-up period in relation to PSA levels were as follows: 0 to 0.49 ng/mL, 0% (0/958); 0.50 to 0.99 ng/mL, 0.9% (17/1992); 1.00 to 1.49 ng/mL, 4.7% (54/1138); 1.50 to 1.99 ng/mL, 12.3% (70/571); 2.00 to 2.49 ng/mL, 21.4% (67/313); 2.50 to 2.99 ng/mL, 25.2% (56/222); 3.00 to 3.99 ng/mL, 33.3% (89/267); 4.00 to 6.99 ng/mL, 38.9% (103/265); 7.00 to 9.99 ng/mL, 50.0% (30/60); and for men with an initial PSA of 10.00 ng/mL or higher, 76.8% (53/69). Not a single case of prostate cancer was detected within 3 years in 2950 men (50.4% of the screened population) with an initial PSA level less than 1 ng/mL. CONCLUSIONS Retesting intervals should be individualized on the basis of the PSA level, and the large group of men with PSA levels of less than 1 ng/mL can safely be scheduled for a 3-year testing interval.

[1]  W. Rüther,et al.  Task force. , 2011, Midwives.

[2]  Hans Lilja,et al.  Results of a randomized, population‐based study of biennial screening using serum prostate‐specific antigen measurement to detect prostate carcinoma , 2004, Cancer.

[3]  Kazuto Ito,et al.  Possibility of re‐screening intervals of more than one year in men with PSA levels of 4.0 ng/ml or less , 2003, The Prostate.

[4]  I. Thompson,et al.  The influence of finasteride on the development of prostate cancer. , 2003, The New England journal of medicine.

[5]  H. Yamanaka,et al.  Diagnostic significance of digital rectal examination and transrectal ultrasonography in men with prostate-specific antigen levels of 4 NG/ML or less. , 2001, Urology.

[6]  H. Carter Rationale for earlier and less frequent prostate cancer screening. , 2001, Urology.

[7]  E. Metter,et al.  Low levels of prostate-specific antigen predict long-term risk of prostate cancer: results from the Baltimore Longitudinal Study of Aging. , 2001, Urology.

[8]  J. Hugosson,et al.  Outcome of Laterally Directed Sextant Biopsies of the Prostate in Screened Males Aged 50–66 Years , 2001, European Urology.

[9]  M. Roobol,et al.  Tumor characteristics in screening for prostate cancer with and without rectal examination as an initial screening test at low PSA (0.0–3.9 ng/ml) , 2001, The Prostate.

[10]  W. Catalona,et al.  Digital rectal examination for detecting prostate cancer at prostate specific antigen levels of 4 ng./ml. or less. , 1999, The Journal of urology.

[11]  L. Holmberg,et al.  The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. , 1997, Urology.

[12]  D. Chan,et al.  Recommended prostate-specific antigen testing intervals for the detection of curable prostate cancer. , 1997, JAMA.

[13]  B. Dalkin,et al.  Prospective longitudinal evaluation of men with initial prostate specific antigen levels of 4.0 ng./ml. or less. , 1997, The Journal of urology.

[14]  M. Stampfer,et al.  A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. , 1995, JAMA.

[15]  D. Neal,et al.  Screening for prostate cancer , 1994, The Lancet.