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| References
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Prostate-screening,
benign enlargement and cancer |
4.
Beemsterboer PM, Kranse R, De KH, Habbema JF, Schroder FH.
Changing role of 3 screening modalities in the European randomized
study of screening for prostate cancer (Rotterdam). International
Journal of Cancer Vol 84.(4.) (pp.437.-441.), 1999.
Abstract: A randomized screening trial was started in Europe
to show the effect of early detection and treatment of prostate
cancer on mortality (European Study on Screening of Prostate
Cancer). In one centre (Rotterdam), the screening protocol
initially consisted of 3 screening tests for all men: prostate-
specific antigen (PSA), digital rectal examination (DRE) and
transrectal ultrasonography (TRUS). A PSA value of >=4
ng/ml and/or an abnormality on DRE and/or TRUS were taken
to indicate that biopsy was required. In this study, we examined
the possibilities for a more efficient screening protocol.
A logistic-regression model was used to predict the number
of cancers for PSA < 4 ng/ml if all men were biopsied (predictive
index, PI). Effects of a change in PSA cut-off on the screening
results were explored. Weights were applied to procedures
and cancers to explore the possibility of expressing differences
between protocols in one overall figure. Biopsies in men with
PSA < 1 ng/ml and a positive DRE or TRUS were very inefficient.
Applying DRE and TRUS only in the PSA ranges 1.5 to 3.9 and
2 to 3.9 ng/ml to determine whether a biopsy was required
would result in a decrease of 29 to 36% in biopsies and a
decrease of 5 to 8% in cancers. However, the results of DRE
and TRUS could not be duplicated entirely. A protocol with
only PSA >= 3 ng/ml as a direct biopsy indicator resulted
in a decrease of detected cancers by 7.6% and of biopsies
by 12%, also a much simpler screening procedure. Use of the
PI would give more efficient protocols, but this should be
viewed as a preliminary finding, with the disadvantage of
necessitating many additional screening visits. Since the
results of DRE and TRUS could not be duplicated, a change
in protocol towards PSA >= 3 ng/ml appears acceptable.
If this proves effective, a final judgement about the optimal
combination of screening tests may be made. [References: 14]
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