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Related Experiment Videos

Prostate cancer detection at low prostate specific antigen.

F H Schröder1, I van der Cruijsen-Koeter, H J de Koning

  • 1Department of Urology, Erasmus University and Academic Hospital, Rotterdam, The Netherlands.

The Journal of Urology
|February 25, 2000
PubMed
Summary

Digital rectal examination and PSA screening miss many aggressive prostate cancers at low levels (0-4.0 ng/ml). More sensitive methods are needed for early detection to avoid missing critical treatment windows.

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Area of Science:

  • Urology
  • Oncology
  • Medical Screening

Background:

  • Prostate-specific antigen (PSA) and digital rectal examination (DRE) are standard for prostate cancer screening.
  • Abnormal DRE often prompts biopsy, even with low PSA levels (0-4.0 ng/ml).
  • The diagnostic accuracy of these methods at low PSA requires further evaluation.

Purpose of the Study:

  • To assess the diagnostic value of PSA, DRE, and transrectal ultrasonography (TRUS) for prostate cancer detection at low PSA levels (0-4.0 ng/ml).
  • To evaluate tumor characteristics of cancers missed at low PSA.
  • To identify limitations in current screening strategies for early prostate cancer detection.

Main Methods:

  • Analysis of data from 9,211 participants (54-74 years) with PSA < 4.0 ng/ml from the European Randomized Study of Screening for Prostate Cancer.

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  • Participants underwent DRE and TRUS.
  • Tumor characteristics (pT category, Gleason score, cancer volume) were analyzed in radical prostatectomy specimens from 166 men, including 50 with PSA 0-4.0 ng/ml.

    • Main Results:

    • The positive predictive value of DRE and TRUS combined was low (9.7%) at PSA 0-4.0 ng/ml.
    • Sensitivity was significantly reduced for detecting cancers in men with PSA 2-4 ng/ml (36.5% detection rate).
    • Approximately half of the missed tumors exhibited aggressive characteristics (Gleason score ≥7) and were organ-confined.

    Conclusions:

    • Current screening methods (PSA, DRE) are insufficient for detecting significant prostate cancers at low PSA levels (0-4.0 ng/ml).
    • A substantial proportion of missed cancers are aggressive and organ-confined, highlighting a missed "window of opportunity" for treatment.
    • Development of more sensitive and selective screening strategies is crucial for effective early prostate cancer detection.