The role of PSA in secondary screening of the same population

This presentation addresses the value of PSA in populations of men that have already been screened, using PSA with an arbitrary cut-off point as a biopsy indication (data from the European Randomised Study of Screening for Prostate Cancer ERSPC, section Rotterdam). The positive predictive value of PSA, i.e., the percentage of men who have a positive biopsy at various PSA cut-off values, has been shown to be different in initial screens and secondary screens 4 years later by Raaijmakers et al. in 2003, using a PSA cut-off of 3 as a biopsy indication in first-round screening, The data refer to 1,850 men biopsied initially and 1,040 biopsied at repeat screening. The possible predictors of a positive biopsy in second-round screening were analysed using multivariate regression analysis. The most important positive predictors were 2-Log PSA, a positive rectal examination or transrectal ultrasonography, age, and a positive family history. The predictive value of PSA changes in pre-screened populations. PSA progression to an arbitrary cut-off of 3 or 4 ng/mL remained important and indicated a positive biopsy rate between 20 and 25% in second-round screening. PSAV is not a diagnostic marker in a screening setting. It may be a marker of cancer aggressiveness. For the time being, the use of arbitrary PSA cut-off values remains an important option for daily clinical practice. Common sense has to prevail until more valid information has become available for proper indications of biopsies in pre-screened populations.