Abstract
BACKGROUND
At the Rotterdam branch of the European Randomized Study of Screening for Prostate Cancer, a cohort of 19,970 men ages 55–75 years is screened at an interval of 4 years. Screening includes systematic sextant needle biopsy for men with elevated prostate‐specific antigen (PSA) levels and/or positive findings on digital rectal examination or transrectal ultrasound. Detection during the second screening round of a large number of high‐grade (Gleason Grade 4 or 5) malignancies and/or a large number of malignancies in general could be considered the result of a failure to identify these malignancies at an early stage, during prevalence screening.
METHODS
Men diagnosed during the second screening round with potentially advanced carcinoma (PAC), characterized by a biopsy Gleason score of 7 (4 + 3, or 3 + 4 with > 30% malignant involvement) or a biopsy Gleason score of 8–10, were identified. Clinical data, including PSA values on prevalence screening, biopsy history, clinical stage, and follow‐up data, were retrieved for these patients. Tumor features were further analyzed in radical prostatectomy specimens.
RESULTS
During the second screening round, 503 malignancies, including 30 (6.0%) with features of PAC on diagnostic biopsy, were detected in 11,210 patients. Curative treatment was offered to 26 patients. Prostatectomy demonstrated the presence of organ‐confined disease in 11 of 12 specimens, and tumor volume ranged from 0.11–7.93 cm^3^ (median, 1.05 cm^3^). PSA failure was noted in 6 of 22 patients who were offered curative therapy.
CONCLUSIONS
PAC is a rare finding in the second round of screening after a 4‐year interval, and a substantial proportion of PAC cases detected in the second screening round represent organ‐confined disease. The findings of the current study suggest that the screening protocol used is sufficiently effective for detecting > 95% of malignancies before they develop features that would make them incurable. Cancer 2004;100:968–75. © 2004 American Cancer Society.