Lead time associated with screening for prostate cancer

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Prostate-specific antigen (PSA) screening is a key strategy for early prostate cancer (PC) detection.
• Quantifying the lead time from screening is crucial for understanding PC development and evaluating screening programs.

Purpose of the Study:

• To compare the lead time of prostate cancer detection between an early detection (ED) program and a reference population (RP).
• To evaluate the impact of initial PSA levels and follow-up duration on lead time in PC screening.

Main Methods:

• A 12-year follow-up study comparing 946 participants in an ED program with 657 men in an age-matched RP.
• ED criteria included digital rectal examination, transrectal ultrasonography, and/or PSA >/=10.0 ng/mL.
• PSA values from frozen serum samples were used for the RP, with a PSA threshold of >/=3.0 ng/mL for comparison.

Main Results:

• The PC incidence in the RP with PSA >/=3.0 ng/mL caught up to the ED group after 10.6 years.
• Median lead time after 12 years was 4.5 years in the ED group versus 7.8 years in the RP.
• With 20 years of follow-up, the RP's median lead time increased to 10.7 years.
• Lead time was influenced by initial PSA levels, follow-up length, and ED sensitivity.
• The described ED program did not result in significant overdetection.

Conclusions:

• Early detection screening for prostate cancer provides a significant lead time, particularly in a reference population with lower PSA thresholds.
• The duration of follow-up and initial PSA levels are key determinants of lead time in prostate cancer.
• The studied early detection program demonstrated effectiveness without substantial overdetection.