Platinum Priority – Collaborative Review – Prostate CancerEditorial by Ian M. Thompson and Donna P. Ankerst on pp. 662–663 of this issueRisk-Based Prostate Cancer Screening☆
Introduction
Prostate cancer (PCa) is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in men, accounting for 14% (903 500) of total new cancer cases and 6% (258 400) of total cancer deaths in men in 2008 [1].
PCa has a variable natural history, ranging from indolent to strikingly aggressive with a long preclinical phase. Because we are still awaiting a breakthrough in the treatment of advanced disease, earlier detection of clinically significant disease currently seems to afford the best opportunity of stemming the tide. In general, there are two approaches to early detection: screen everyone within a certain age range (eg, breast cancer and cervical cancer) or screen selectively based on risk factors (eg, lung cancer).
For PCa screening, evidence of mortality reduction was shown by prostate-specific antigen (PSA)–based screening in the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the overlapping Göteborg trial [2], [3], [4]. Although several associations in Europe and the United States have updated their guidelines regarding PCa screening (Table 1), widespread mass screening is not recommended because the achieved mortality reduction comes with considerable harm such as unnecessary biopsies, overdiagnoses, and subsequent overtreatment [3], [5], [6]. Therefore, patient stratification with regard to PCa risk and aggressiveness is necessary to identify those men who are at risk and may actually benefit from early detection [7], [8]. In other words, a risk-based strategy is necessary to prevent unnecessary PSA testing and widespread overdiagnoses.
With the current screening algorithm applied in the ERSPC, the relative mortality reduction after a median follow-up of 9 yr is modest at 20–30% [2], [3]. A recent study from the ERSPC group showed that noncompliance with the screening protocol and aggressive interval cancers were attributed to a significant proportion of the PCa deaths in the intervention arm [9]. With a risk-based strategy, we may improve the screening effect. First, those with intermediate and high risk may be screened with a shorter interval, which may lead to fewer aggressive interval cancers. Second, the compliance might increase among those at high risk if they were informed of their risk status, resulting in fewer nonattendees after being screened once. This review critically examines the current evidence regarding risk-based PCa screening.
Section snippets
Evidence acquisition
To apply a risk-based screening strategy, one must first identify the risk factors. Thus in this review we considered articles that evaluated factors predicting the presence of PCa. It is important to realize that some markers predict the risk of either current or future PCa, and others have predictive value in both cases. We also highlighted some of the most frequently used prediction tools that assess the chance of having PCa.
A search of the literature was performed using the Medline database
Age
The association between increasing age and PCa risk is very strong [10], [11], [12], [13]. However, across the relatively narrow age range typically encountered in many screening programs, age may not be an independent predictor of risk. Schröder et al. showed that age (per year or per decade) was not a statistically significant predictor for PCa in men 55–70 yr at the initial screen, unlike PSA, previous negative biopsy (yes or no), and prostate volume, which were predictive [14].
We do not yet
Conclusions
To date, PSA has been shown to be the single most significant predictive factor for identifying men at increased risk of developing PCa. Especially in men with no additional risk factors, PSA alone provides an appropriate marker up to 30 yr into the future. After assessment of an early PSA test, the screening frequency may be determined based on individualized risk. Although retrospective data strongly point toward the potential of risk-stratifying men, outcomes such as unnecessary testing,
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Association of MyProstateScore (MPS) with prostate cancer grade in the radical prostatectomy specimen
2022, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :Although screening with serum prostate-specific antigen (PSA) has been shown to reduce prostate cancer (PCa) mortality [1–3], PSA is poorly specific for PCa diagnosis and clinically significant PCa (Grade Group ≥2 [GG ≥ 2]), such that a significant subset of biopsies performed prove to be unnecessary (i.e., negative or GG1) [4]. As such, there is substantial need to better define the risk and detection of GG ≥ 2 cancer in men traditionally referred for prostate biopsy, thereby sparing patients without cancer and those with low-grade disease from invasive, costly, and anxiety-provoking PCa evaluation [5]. Supplementing serum PSA with additional, cancer-specific biomarkers is one potential solution.
The STHLM3-model, Risk-based Prostate Cancer Testing Identifies Men at High Risk Without Inducing Negative Psychosocial Effects
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2020, Pathology Research and PracticePerformance of Artificial Intelligence-Aided Diagnosis System for Clinically Significant Prostate Cancer with MRI: A Diagnostic Comparison Study
2023, Journal of Magnetic Resonance Imaging
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