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Prostate Specific Antigen and Biopsy Contamination in the Göteborg-1 Randomized, Population-Based, Prostate Cancer
K Stinesen Kollberg1,2, E Holmberg3,4, A Josefsson1,5,6
1Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
The Journal of Urology
|June 30, 2022
Summary
Pre-testing and contamination in prostate cancer screening trials can dilute true effects. The Göteborg-1 trial found organized screening more effective due to younger start ages and fewer biopsies from contamination.
Area of Science:
- Urology
- Oncology
- Public Health
Background:
- Prostate cancer screening effectiveness can be influenced by pre-testing and contamination.
- Understanding these factors is crucial for accurately assessing screening benefits.
Purpose of the Study:
- To quantify pre-testing and contamination levels in the Göteborg-1 prostate cancer screening trial.
- To analyze the impact of contamination on the perceived effectiveness of screening.
Main Methods:
- Randomized 20,000 men aged 50-64 (1994-2014) into screening (PSA testing every 2 years) and control groups.
- Assessed prostate-specific antigen (PSA) testing rates, contamination, and biopsy referrals.
- Defined positive PSA test as ≥3 ng/ml.
Main Results:
- Pre-testing rates were similar (4.2% screening vs. 4.6% control).
- Contamination was high: 72% in control vs. 87% in screening group underwent PSA testing.
- Fewer contamination-related biopsies occurred: 28% in control vs. 66% in screening group.
Conclusions:
- Similar PSA testing proportions but fewer biopsies from contamination in the control group.
- Organized screening is more effective in reducing prostate cancer mortality.
- Properly conducted organized screening may yield even greater mortality reductions than previously estimated.
