To determine the feasibility of a digitally automated population-based programme for organised prostate cancer testing (OPT) in Southern Sweden.
A pilot project for a regional OPT was conducted between September 2020 and February 2021, inviting 999 randomly selected men aged 50, 56, or 62 years (y). Risk stratification was based on PSA, PSA density (PSAD), and biparametric prostate MRI. Men with a PSA level of 3-99 ng/mL had an MRI, and men with elevated PSA (≥ 3 ng/mL) had a urological check-up, including a DRE and TRUS. Indications for targeted and/or systematic transrectal prostate biopsies were suspicious lesions on MRI (prostate imaging reporting and data system [PI-RADS] 4-5) and/or PSAD > 0.15 ng/mL/cm3 . Additional indications for prostate biopsies were palpable tumours, PSA ratio < 0.1, or cancer suspicion on TRUS. Patient selection, mail correspondence, data collection, and algorithm processing were performed by an automated digital management system. Feasibility is reported descriptively.
A total of 418 men had a PSA test (42%), with increasing participation rates by age (50y, 38%; 56y, 44%; and 62y, 45%). Among these, 35 men (8%) had elevated PSA (≥ 3 ng/mL: 50y, 1/139; 56y, 10/143; and 62y, 24/146). On MRI, 16 men (48%) had a negative scan (PI-RADS < 3), seven men (21%) had PI-RADS 3, nine men (27%) had PI-RADS 4, and one man (3%) had PI-RADS 5. All men with PI-RADS 4 or 5 underwent prostate biopsies, as well as two men with PI-RADS 3 due to PSAD > 0.15 ng/mL/cm3 or a suspicious finding on TRUS. Prostate cancer was diagnosed in ten men. Six men underwent active treatment, whereas four men were assigned to active surveillance.
Our OPT model is feasible from an operational point of view, but due to the limited scale of this study no conclusions can be made regarding the efficacy of the diagnostic model or outcome.
BJU international. 2023 Jul 31 [Epub ahead of print]
Max Alterbeck, Erik Thimansson, Johan Bengtsson, Erik Baubeta, Sophia Zackrisson, Anetta Bolejko, Kevin Sandeman, Sigrid Carlsson, Thomas Jiborn, Anders Bjartell
Department of Urology, Skåne University Hospital, Malmö, Sweden., Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden., Department of Clinical Pathology and Molecular Diagnostics, Medical services, Malmö, Sweden., Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.