To screen for prostate or not … Europe undecided

To screen or not to screen for prostate cancer in men remains in question in Europe as two recent studies presented at the European Urology Association meeting last month reveal. In a session on screening, two urologists, Dr. Schroeder of Rotterdam and Dr. Pelzer of Innsbruck, presented data in support of contrasting positions.

Dr. Schroeder, Rotterdam, in a presentation on "How to Screen for Prostate Cancer (PC) in Men presenting with Low PSA (less than 3.0ng/ml) - Do We Have to Find All Cancers?" said,it's OK to let men go 4 years between PSA tests because the number who develop incurable cancer in between is small.

His study screened 15,852 men and found that 79% presented with a PSA less than 3.0ng/ml at the first screen. These men received no immediate follow up but were expected to be re-screened 4 years later.

Out of this group, 14 men developed detectable prostate cancer before the 4 year follow, and 2 of them were found to have higher than stage T2 disease, making their cancer potentially incurable.

The number of 14 does not look high, but the men were re-screened at 4 years, 1,090 showed PSA progression to above 3.0ng/ml and were biopsied. Prostate cancer PC was detected in a quarter of those men -- 275 (25%) -- and 7 were potentially incurable (including 2 metastatic cases).

Dr. Schroeder concludes that since these numbers show that 95% of cases detected as interval PC or after PSA progression are still potentially confined and curable, mopre frequent screening is not necessary.

Dr. Pelzer, Innsbruck presented data to show, on the other hand, that the grade of prostate cancer found in men who have previously undergone screening is more favorable to the patient's survival compared to prostate cancer detected in "non-screened men."

Of 997 men who underwent prostate removal surgeries (radical prostatectomies, or RPs) in Dr. Petzer's service at Innsbruck hospital in the period 1999-2006, 806 men were being treated after detection of prostate cancer through screening; whereas 191 were referred from the general, non-screened population after some ad hoc test or symptomatic evidence of prostate cancer.

Patient age and PSA levels were similar between the groups. The screen-detected patients, though, had statistically lower pathologic stages at surgery and lower Gleason scores. The rate of positive surgical margins was 11.7% in the screened group and 24.4% in the non-screened group. The worse pathologic variables suggest that the non-screened group is at higher risk for disease relapse compared to the screened patients.

"This study suggests," Petzer writes, "that screening volunteers have a statistically significant higher rate of organ confined prostate cancers, a statistically significant lower rate of extracapsular extension and positive surgical margins compared to their counterparts in the referral population even in the same fPSA (free PSA) range. Since the pathological stage and surgical margins status are significant predictors of recurrence, these findings support the concept of PSA screening."

EAU 2007 - Abstract#606
-a href="">How to Screen for Prostate Cancer (PC) in Men Presenting with Low PSA (less than 3.0 ng/mL)? Do We Have to Find All Cancers?

EAU 2007 - Abstract#611
-Clinical and Pathological Features of Screen vs. Non Screen Detected Prostate Cancers: Is There a Difference?

More anstracts from the EAU one session on Prostate Cancer Screening