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EAU 2017

EAU 2017: Is further screening of Asian men with low baseline prostate-specific antigen levels (≤ 1ng/ml) worthwhile

London, England (UroToday.com) Frequent PSA screening results in considerable increase in detection of incidental and indolent prostate cancers. Current guidelines recommend variable screening intervals for men with PSA levels ≤ 1ng/ml. For example, the EAU recommends 8 years and the Japanese Urological Association recommends 3 years. The objective of the present study was to establish an optimal screening system to maximize PSA screening-related mortality reduction and cost-effectiveness for middle aged men in Japan with low PSA.

Subjects were between 54 and 69 years of age. A total of 22,262 men were included. Of these 12,412 had an initial PSA ≤ 1ng/ml. From these patients, 8,086 men with at least 2 screening PSA tests were included in the analysis. Over the course of the screening protocol, 474 (5.86%) men had an increase in their PSA to ≥ 2 ng/ml which prompted further exploration (e.g. biopsy). Of the men who were biopsied, only 46 (0.57%) were found to have a clinically significant prostate cancer (defined as Gleason sum 7 or higher). The median duration from initial to last screening was 4.8 years and the median number of PSA tests was 4. PSA levels were then stratified by number and cumulative probabilities of an increase to ≥ 2 ng/ml based on the initial PSA were calculated. From this, the authors were able to conclude that for patients with PSA levels ≤ 0.6ng/ml, screening intervals can likely be safely extended to 10 years. However, for PSA levels between 0.6-1.0 ng/ml, a 3-year screening interval is preferred. These results suffer from a lack of generalizability, but will provide sound clinical evidence around which to base decisions in Japan.

Lead Author: S. Urata

Institution: Kanazawa University, Japan

Written by: Benjamin T. Ristau, MD, SUO Fellow, Fox Chase Cancer Center, Philadelphia, PA.

at the #EAU17 -March 24-28, 2017- London, England