Prostate Cancer Screening (eBook)

I. Trends in prostate cancer screening 1) Overview of US Prostate Cancer Trends in the Era of PSA Screening Ruth Etzioni, MD, Roman Gulati, Angela Mariotto, PhD. 2) Trends in Prostate Cancer Screening: Overview of the UK Freddie C Hamdy, MD, Richard J Bryant, MD 3) Trends in prostate cancer screening: Canada Robert K Nam, MD, Laurence H Klotz, MD 4) Trends in prostate cancer screening: Europe Sanjai Addla, FRCS, Robert Djavan, MD, PhD II. Prostate Specific Antigen 5) Evolution of Prostate Specific Antigen for screening Javier Hernandez, MD, MS, Edith Canby-Hagino, MD, MS 6) The performance characteristics of prostate specific antigen for prostate cancer screening Ian M. Thompson, MD, Donna P. Ankerst, PhD 7) The performance of PSA after a prior negative prostate biopsy Catherine M Tangen, Dr. PH 8) Subfractions and derivatives of total prostate specific antigen in the early detection of prostate cancer Alexander Haese, MD, PhD, Alan W Partin, MD, PhD 9) PSA velocity at presentation as a predictor of prostate cancer aggressiveness Jason A Efstathiou, MD, PhD, Anthony D’Amico, MD, PhD III. Risk assessment for prostate cancer 10) Nomograms for prostate cancer Shahrokh F Shariat, MD, Mike W Kattan, MD 11) Artificial neural networks for optimizing prostate cancer risk prediction Felix K.-H. Chun, MD, Pierre I. Karakiewicz, MD 12) Development of the Prostate Cancer Prevention Trial Prostate Cancer Risk Calculator Donna P Ankerst, PhD, Ian M Thompson, MD 13) Integration of risk assessment in prostate cancer screening Kadee Thompson, MD, Amanda Reed, MD, Dipen J Parekh, MD 14) Family history ofprostate cancer during rapidly increasing incidence Kari Hemminki, MD, Justo Lorenzo Bermelo, MD IV. Recent biomarkers for prostate cancer 15) PSA Isoforms:[-2]proPSA Significant Adjunct to Free PSA Jeffrey E Tam 16) PCA3 Jack Groskopf, PhD, Jack Schalken, PhD, Harry Rittenhouse, PhD 17) Transcriptional profiling for prostate cancer biomarker identification and clinical applications Nigel Clegg, PhD, Peter S Nelson, MD 18) Biomarkers for prostate cancer detection: family-based linkage analysis and case-control association studies Joke Beuten, Teresa L Johnson-Pais. 19) GSTP1 hypermethylation for prostate cancer detection Rui Henrique, MD, PhD, Carmen Jeronimo, PhD 20) EPCA and EPCA-2 as potential biomarkers for prostate cancer detection Eddy S Leman, PhD, Robert H Getzenberg, PhD V. Design and methodologic considerations in biomarker studies 21) Towards a robust system for biomarker triage and validations—EDRN experience Ziding Feng, PhD 22) Statistical evaluation of markers and risk tools for prostate cancer classification and prediction Yingye Zheng, PhD, Donna P Ankerst, PhD 23) Pitfalls in prostate cancer biomarker evaluation studies Donna P Ankerst, PhD VI. Building upon recently completed and ongoing prospective trials 24) Prostate-specific antigen and its role on the Prostate Cancer Prevention Trial Catherine M Tangen, Dr. PH, Phyllis Goodman, MS 25) The selenium and vitamin E cancer prevention trial Eric A Klein, MD, Catherine M Tangen, Dr. PH 26) PLCO: A randomized controlled screening trial for prostate, lung, colorectal and ovarian cancer Amanda Black, PhD, E David Crawford, MD, Robert L Grubb,

WHAT HAPPENED IN THE UK SINCE THE INTRODUCTION OF PSA TESTING? (S. 17-18)

A small scale study of screening acceptability was performed in the UK in the late 1980s, which demonstrated that men in the community will attend for PSA testing if invited (6). As PSA testing became widely available in the following years, the Department of Health discouraged the use of PSA testing for prostate cancer screening, until the late 1990s. In 1995, the Health Technology Assessment (HTA) programme commissioned two systematic reviews of the literature, which clearly stated that there was insufficient evidence to recommend mass-screening for prostate cancer as a public health policy (7,8).

The reviews recommended that urgent research into screening and treatment of prostate cancer should be undertaken in the form of large RCTs. Subsequently, HTA issued a call for primary research in this area, and commissioned the feasibility phase of the ProtecT (Prostate testing for cancer and Treatment) study, followed by the full trial in 2001 (9,10). The ProtecT study is currently the largest randomised controlled trial of treatment effectiveness in prostate cancer worldwide. The feasibility phase demonstrated that screening was acceptable amongst British men, and that the majority agreed to be randomised to a three-arm trial of active monitoring, radical prostatectomy, and 3-D conformal radiotherapy.

The main trial started in 2001, and aims to test 130,000 asymptomatic men aged 50–70 years over a period of 5 years. Of those, 1,800 patients with clinically localised prostate cancer will be randomised to active monitoring, radical prostatectomy, or radiotherapy. The primary end-point will be survival at 10 years, with a number of secondary end-points including detailed quality of life analyses.

The study has been extended through further support from Cancer Research, UK and the Department of Health to include the evaluation of case-finding. This effectively converted the ProtecT study into the intervention arm of a clustered randomised trial of screening. Recruitment to the study is near completion, and results will become available within the next decade, at the same time as the other much awaited screening studies in Europe and the USA.

By the year 2000, the UK Department of Health recommended that if a man requested PSA testing to be screened for prostate cancer, careful counselling should be givenregarding the uncertainties surrounding the diagnosis and treatment of the disease, and PSA testing should be performed only after the man is fully informed and able to make such a decision. Despite the absence of a proven benefit from PSA-based prostate cancer screening recent years have seen a modest rise in the number of men undergoing ad hoc PSAtest screening in the UK.

A study in England and Wales suggests that the annual rate of PSA testing in men aged 45–84 years without a previous prostate cancer diagnosis is approximately 6% (11), which remains low compared to rates of testing in Western Europe and in the USA where a recent estimate suggested testing rates of over 25% in men aged 50–75 years (12).