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Related Experiment Videos

Prostate-specific antigen as a screening test. The Netherlands experience

C H Bangma1, J B Rietbergen, F H Schröder

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

The Urologic Clinics of North America
|May 1, 1997
PubMed
Summary

This study on prostate cancer screening found that the free-to-total PSA ratio significantly improves detection accuracy. This helps reduce unnecessary biopsies in men aged 54-76, enhancing screening efficiency.

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Area of Science:

  • Urology
  • Oncology
  • Preventive Medicine

Background:

  • Prostate cancer screening involves Prostate-Specific Antigen (PSA) testing, Digital Rectal Exams (DRE), and Transrectal Ultrasound (TRUS).
  • The Rotterdam site of the European Randomized Study of Prostate Cancer (ERSPC) has randomized approximately 9600 men aged 54-76 for screening.
  • Initial screening involved PSA, DRE, and TRUS, with a cancer detection rate of 4.3% and a biopsy-to-carcinoma rate of 5.1.

Purpose of the Study:

  • To evaluate methods for improving the specificity of PSA testing in the intermediate range (4-10 ng/mL).
  • To assess the effectiveness of the free-to-total PSA (f-PSA/t-PSA) ratio, PSA density, and age-specific ranges in optimizing prostate cancer detection.
  • To determine the impact of these improved parameters on reducing unnecessary biopsies while maintaining cancer detection rates.

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Main Methods:

  • Analysis of data from 9600 men undergoing prostate cancer screening.
  • Comparison of total serum PSA, DRE, f-PSA/t-PSA ratio, PSA density, and age-specific ranges as predictors of positive biopsies.
  • Evaluation of the f-PSA/t-PSA ratio with a cut-off of 0.20 in conjunction with DRE.

Main Results:

  • Total serum PSA was the best sole predictor of a positive biopsy, followed by DRE.
  • The f-PSA/t-PSA ratio significantly improved specificity in the intermediate PSA range.
  • Using the f-PSA/t-PSA ratio (cut-off 0.20) combined with DRE reduced biopsies by 38% in the intermediate range, with only a 12% increase in undetected carcinomas, leading to an overall biopsy-to-carcinoma ratio of 4.6.

Conclusions:

  • The f-PSA/t-PSA ratio is a highly effective parameter for improving prostate cancer screening specificity.
  • Combining f-PSA/t-PSA ratio with DRE can significantly reduce the number of biopsies needed in men with intermediate PSA levels.
  • These findings suggest a modification of the screening procedure within the ERSPC study is warranted.