Screening for prostate cancer without digital rectal examination and transrectal ultrasound: Results after four years in the European Randomized Study of Screening for Prostate Cancer (ERSPC), Rotterdam
- 30 December 2005
- journal article
- research article
- Published by Wiley in The Prostate
- Vol. 66 (6), 625-631
- https://doi.org/10.1002/pros.20359
Abstract
BACKGROUND Omission of DRE/TRUS as biopsy indication results in fewer unnecessary biopsies, but may increase the risk of missing potentially aggressive prostate cancers (PCs). In 1997, the biopsy indication within the ERSPC was changed from a PSA cut‐off of 4.0 ng/ml and/or abnormal DRE/TRUS (group‐1) to solely a PSA cut‐off of 3.0 ng/ml (group‐2). We estimated the effect of omitting DRE/TRUS by comparing the results of a re‐screening 4 years after initial screening to the original policy. METHODS We compared rate and characteristics of detected PCs in the second round in men initially screened in group‐1 (N = 5,957) or group‐2 (N = 8,044). Additionally, we compared the rate of interval cancers (ICs) after screening with and without DRE/TRUS. RESULTS There was no significant difference in second round cancer‐detection‐rates (group‐1, 3.0%; group‐2, 2.7%), positive‐predictive‐values (group‐1, 23.9%; group‐2, 26.3%), and number of poorly‐differentiated tumors (group‐1, 2.6%; group‐2, 3.8%). Most PCs were clinically confined to the prostate. Eleven ICs were detected in each group (0.18 and 0.14%). CONCLUSIONS Omitting DRE/TRUS did not result in an increased IC‐ or PC‐detection. However, considering the natural history of PC, the 4‐year follow‐up may be too short to draw a definitive conclusion. Prostate 66:625–631, 2006.Keywords
This publication has 17 references indexed in Scilit:
- Serendipity in detecting disease in low prostate‐specific antigen rangesBJU International, 2002
- Tumor characteristics in screening for prostate cancer with and without rectal examination as an initial screening test at low PSA (0.0-3.9 ng/ml)The Prostate, 2001
- Prostate-specific antigen-based early detection of prostate cancer—validation of screening without rectal examinationUrology, 2001
- DIGITAL RECTAL EXAMINATION FOR DETECTING PROSTATE CANCER AT PROSTATE SPECIFIC ANTIGEN LEVELS OF 4 NG./ML. OR LESSJournal of Urology, 1999
- Evaluation of the Digital Rectal Examination as a Screening Test for Prostate CancerJNCI Journal of the National Cancer Institute, 1998
- Comparison of pathologic characteristics of T1c and non-Tic cancers detected in a population-based screening study, the European randomized study of screening for prostate cancerWorld Journal of Urology, 1997
- Evaluation of prostate‐specific antigen, digital rectal examination and transrectal ultrasonography in population‐based screening for prostate cancer: improving the efficiency of early detectionBritish Journal of Urology, 1997
- Systematic 5 Region Prostate Biopsy is Superior to Sextant Method for Diagnosing Carcinoma of the ProstateJournal of Urology, 1997
- The TNM classification of prostate cancerThe Prostate, 1992
- Transrectal ultrasound in the diagnosis and staging of prostatic carcinoma.Radiology, 1989