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Krilaviciute A, Becker N, Lakes J, Radtke JP, Kuczyk M, Peters I, Harke NN, Debus J, Koerber SA, Herkommer K, Gschwend JE, Meissner VH, Benner A, Seibold P, Kristiansen G, Hadaschik B, Arsov C, Schimmöller L, Giesel FL, Antoch G, Makowski M, Wacker F, Schlemmer HP, Kaaks R, Albers P. Digital Rectal Examination Is Not a Useful Screening Test for Prostate Cancer. Eur Urol Oncol 2023; 6:566-573. [PMID: 37806841 DOI: 10.1016/j.euo.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Annual digital rectal examination (DRE) is recommended as a stand-alone screening test for prostate cancer (PCa) in Germany for 45+ yr olds. DRE diagnostic performance in men as young as 45 yr old has not been proved by a screening trial. OBJECTIVE To determine DRE diagnostic performance in a screening trial. DESIGN, SETTING, AND PARTICIPANTS This analysis was conducted within the multicentric, randomized PROBASE trial, which enrolled >46 000 men at age 45 to test risk-adapted prostate-specific antigen (PSA) screening for PCa. INTERVENTION (1) DRE was analyzed as a one-time, stand-alone screening offer at age 45 in 6537 men in one arm of the trial and (2) PCa detection by DRE was evaluated at the time of PSA-screen-driven biopsies (N = 578). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS (1) True-/false-positive detection rates of DRE as compared with PSA screening and (2) DRE outcome at the time of a prostate biopsy were evaluated. RESULTS AND LIMITATIONS (1) A prospective analysis of 57 men with suspicious DRE at age 45 revealed three PCa. Detection rate by DRE was 0.05% (three of 6537) as compared with a four-fold higher rate by PSA screening (48 of 23 301, 0.21%). The true-positive detection rate by DRE relative to screening by PSA was 0.22 (95% confidence interval [CI] = [0.07-0.72]) and the false-positive detection rate by DRE was 2.2 (95% CI = [1.50-3.17]). (2) Among PSA-screen-detected PCa cases, 86% had unsuspicious DRE (sensitivity relative to PSA was 14%), with the majority of these tumors (86%) located in the potentially accessible zones of the prostate as seen by magnetic resonance imaging. CONCLUSIONS The performance of stand-alone DRE to screen for PCa is poor. DRE should not be recommended as a PCa screening test in young men. Furthermore, DRE does not improve the detection of PSA-screen-detected PCa. PATIENT SUMMARY Our report demonstrated the poor diagnostic performance of digital rectal examination in the screening for prostate cancer in young men.
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Affiliation(s)
- Agne Krilaviciute
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nikolaus Becker
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jale Lakes
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Markus Kuczyk
- Department of Urology, Medical University Hannover, Hannover, Germany
| | - Inga Peters
- Department of Urology, Medical University Hannover, Hannover, Germany
| | - Nina N Harke
- Department of Urology, Medical University Hannover, Hannover, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Ruprecht Karls University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Kathleen Herkommer
- Department of Urology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Valentin H Meissner
- Department of Urology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Petra Seibold
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (dktk), University Hospital Essen, Essen, Germany
| | - Christian Arsov
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Frederik Lars Giesel
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Marcus Makowski
- Institute of Diagnostic and Interventional Radiology, Technical University Munich, Munich, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Medical University Hannover, Hannover, Germany
| | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Albers
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany.
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Ciatto S, Bonardi R, Lombardi C, Zappa M, Gervasi G. Determining the Sensitivity of Transrectal Ultrasonography on a Consecutive Series of Prostate Cancers in a Clinical and Screening Setting. TUMORI JOURNAL 2018; 88:281-3. [PMID: 12400977 DOI: 10.1177/030089160208800407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To evaluate the sensitivity at transrectal ultrasonography (TRUS) for prostate cancer. Material A consecutive series of 170 prostate cancers identified by matching local cancer registry and TRUS archives at the Centro per lo Studio e la Prevenzione Oncologica of Florence. Method TRUS sensitivity was determined as the ratio of TRUS positive to total prostate cancers occurring at different intervals from TRUS date. Univariate and multivariate analyses of sensitivity determinants were performed. Results Sensitivity at 6 months, 1, 2 and 3 years after the test was 94.1% (95% Cl, 90-98), 89.8% (95% Cl, 85-95), 80.4% (95% Cl, 74-87) and 74.1% (95% Cl, 68-81%), respectively. A higher sensitivity (statistically significant) of TRUS was observed only if digital rectal examination was suspicious, whereas no association to sensitivity was observed for age, prostate-specific antigen or prostate-specific antigen density. Conclusions The study provided a reliable estimate of TRUS sensitivity, particularly reliable being checked against a cancer registry: observed sensitivity was high, at least of the same magnitude of other cancer screening tests. TRUS, which is known to allow for considerable diagnostic anticipation and is more specific than prostate-specific antigen, might still be considered for its contribution to a screening approach.
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Ciatto S, Bonardi R, Mazzotta A, Santoni R. Reliability of volume or age-adjusted prostate specific antigen to improve diagnostic accuracy. Int J Biol Markers 2018; 10:226-8. [PMID: 8750650 DOI: 10.1177/172460089501000407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prostate Specific Antigen (PSA), PSA density, PSA excess, and PSA age-specific range have been compared in 331 subjects (35 cancers, 296 benign) with equivocal findings at screening by PSA or palpation + transrectal ultrasonography. The specificity of PSA using a cut-off of 4 ng/ml was only 0.49. A cutoff of 10 ng/ml improved the specificity to 0.88 but the sensitivity decreased from 0.97 to 0.63. The sensitivity and specificity for PSA density (cutoff 0.15), PSA excess (cutoff -5), and age-specific range were 0.86 and 0.80, 0.80 and 0.82, and 0.91 and 0.67, respectively. Avoided benign biopsies vs missed cancers on the basis of PSA density, PSA excess and PSA age-specific range would have been 19 and 5, 26 and 7, and 16 and 3, respectively. Methods adjusting for prostate volume allow a better interpretation of PSA values and may reduce the benign biopsy rate, but the consequent cost of delayed cancer diagnoses when the choice of biopsy is based only on these methods seems unacceptable.
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Affiliation(s)
- S Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Firenze, Italy
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Chwatko G, Forma E, Wilkosz J, Głowacki R, Jóźwiak P, Różański W, Bryś M, Krześlak A. Thiosulfate in urine as a facilitator in the diagnosis of prostate cancer for patients with prostate-specific antigen less or equal 10 ng/mL. Clin Chem Lab Med 2014; 51:1825-31. [PMID: 23843582 DOI: 10.1515/cclm-2013-0069] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 06/17/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to examine the level of thiosulfate in the urine of prostate cancer (PCa) patients and evaluate its usefulness in the diagnosis and monitoring of prostate malignant transformation. Thiosulfate is a naturally occurring product of hydrogen sulfide (H2S) metabolism. H2S is involved in many physiological and pathological processes including inflammation and tumorigenesis. METHODS The determination of thiosulfate in the urine of PCa patients and healthy controls was performed by reverse-phased liquid chromatography using 2-chloro-1-methylquinolinium tetrafluoroborate as a derivatization reagent. Thiosulfate concentrations were normalized to urinary creatinine levels to compensate for variable diuresis. RESULTS In the urine samples of PCa patients, the mean thiosulfate level was almost 50 times higher than in the control groups and five times higher than in the benign prostatic hyperplasia group. The level of thiosulfate did not correlate with the serum prostate-specific antigen (PSA) level or PSA density. Neither tumor stage nor tumor grade was associated with thiosulfate level. CONCLUSIONS The results suggest that thiosulfate concentration in urine may be a good facilitator in the diagnostics of PCa. The predictive accuracy of this method is particularly valuable for the diagnosis of patients with low serum PSA level and negative digital rectal examination and transrectal ultrasound results.
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Sardana G, Jung K, Stephan C, Diamandis EP. Proteomic analysis of conditioned media from the PC3, LNCaP, and 22Rv1 prostate cancer cell lines: discovery and validation of candidate prostate cancer biomarkers. J Proteome Res 2008; 7:3329-38. [PMID: 18578523 DOI: 10.1021/pr8003216] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Early detection of prostate cancer is problematic due to the lack of a marker that has high diagnostic sensitivity and specificity. The prostate specific antigen (PSA) test, in combination with digital rectal examination, is the gold standard for prostate cancer diagnosis. However, this modality suffers from low specificity. Therefore, specific markers for clinically relevant prostate cancer are needed. Our objective was to proteomically characterize the conditioned media from three human prostate cancer cell lines of differing origin [PC3 (bone metastasis), LNCaP (lymph node metastasis), and 22Rv1 (localized to prostate)] to identify secreted proteins that could serve as novel prostate cancer biomarkers. Each cell line was cultured in triplicate, followed by a bottom-up analysis of the peptides by two-dimensional chromatography and tandem mass spectrometry. Approximately, 12% (329) of the proteins identified were classified as extracellular and 18% (504) as membrane-bound among which were known prostate cancer biomarkers such as PSA and KLK2. To select the most promising candidates for further investigation, tissue specificity, biological function, disease association based on literature searches, and comparison of protein overlap with the proteome of seminal plasma and serum were examined. On the basis of this, four novel candidates, follistatin, chemokine (C-X-C motif) ligand 16, pentraxin 3 and spondin 2, were validated in the serum of patients with and without prostate cancer. The proteins presented in this study represent a comprehensive sampling of the secreted and shed proteins expressed by prostate cancer cells, which may be useful as diagnostic, prognostic or predictive serological markers for prostate cancer.
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Affiliation(s)
- Girish Sardana
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Sheikh M, Sinan T, Kehinde EO, Hussein AY, Anim JT, Al-Hunayan AA. Relative contribution of digital rectal examination and transrectal ultrasonography in interpreting serum prostate-specific antigen values for screening prostate cancer in Arab men. Ann Saudi Med 2007; 27:73-8. [PMID: 17356323 PMCID: PMC6077036 DOI: 10.5144/0256-4947.2007.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This study was conducted to determine the utility of digital rectal examination (DRE), transrectal ultrasonography (TRUS) and serum prostate-specific antigen (PSA) in the diagnosis of prostate cancer in men in Arabia, an are of the world with a relatively low incidence of this disease. PATIENTS AND METHODS 329 patients suspected of having prostate cancer on account of raised serum PSA level (>4 ng/ml), DRE or TRUS findings, underwent TRUS-guided prostate biopsy. Raised PSA individually as well as combined, or a lesion suspicious of carcinoma on DRE or TRUS was recorded as PSA(+), DRE(+) or TRUS(+), respectively. The contribution of DRE, TRUS and serum PSA to the diagnosis of prostate cancer was analysed. RESULTS Of the 329 patients who had prostate biopsies 109 cases (33.1%) had PCa. Of these 109 patients 56 (51%) had DRE(+), 77 (42%) had TRUS(+) and 49 (66%) had both DRE(+) and TRUS(+). Statistical analysis revealed that DRE(+) tripled the probability for cancer. PSA over a range of 10-50 ng/mL demonstrated an increasing cancer probability ranging from 2 to 3 fold. TRUS(+) was only significantly associated with cancer risk if PSA was elevated. The presence of all three factors increased the cancer probability by 6 to 7 fold. CONCLUSION TRUS findings are dependent on PSA for interpretation while DRE(+) with elevated PSA makes PCa more likely.
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Affiliation(s)
- Mehraj Sheikh
- Department of Radiology, Faculty of Medicine, Kuwait University P.O. Box 24923, Safat, 13110 Kuwait.
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Sardana G, Marshall J, Diamandis EP. Discovery of candidate tumor markers for prostate cancer via proteomic analysis of cell culture-conditioned medium. Clin Chem 2007; 53:429-37. [PMID: 17259234 DOI: 10.1373/clinchem.2006.077370] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prostate-specific antigen measurement, widely used for early detection of prostate cancer (CaP), suffers from low specificity. Additional tumor markers are needed for the early detection of clinically relevant CaP. Our objective was to perform a qualitative proteomic analysis of conditioned medium (CM) from the CaP cell line PC3(AR)(6). METHODS We used a roller bottle culture system to culture the PC3(AR)(6) cell line in chemically defined serum-free medium for 14 days. By using strong anion-exchange chromatography, we fractionated the CM and trypsinized the fractions. The tryptic peptides were further fractionated by reversed-phase C-18 chromatography before being subjected to electrospray ionization tandem mass spectrometry. We used MASCOT software to search the mass spectra generated and organized identified proteins based on their genome ontology classification of cellular location. We used an immunoassay to measure a newly identified secreted protein, Mac-2BP, and kallikreins 5, 6, and 11 in serum samples from CaP patients and healthy men. RESULTS We classified 262 proteins according to cellular location; the sample was found to contain a significant proportion of secreted (23%) and membrane (16%) proteins. In a proportion of cancer patients compared with healthy men, we determined by ELISA that serum concentrations of a novel candidate biomarker Mac-2BP were increased. CONCLUSIONS These identified proteins, and possibly many others found in the CM, may have utility as novel CaP biomarkers.
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Affiliation(s)
- Girish Sardana
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Ciatto S, Gervasi G, Gorini G, Lombardi C, Zappa M, Crocetti E. Prostate cancer specific mortality in the Florence screening pilot study cohort 1992–1993. Eur J Cancer 2006; 42:1858-62. [PMID: 16829070 DOI: 10.1016/j.ejca.2006.01.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 01/13/2006] [Accepted: 01/17/2006] [Indexed: 10/24/2022]
Abstract
The impact of screening on prostate cancer mortality is still unknown. A favourable impact is suggested by uncontrolled and possibly biased studies. Mortality from all causes and from prostate cancer was assessed in a cohort of 6,861 males aged 60-74 years, participants to a pilot screening study during 1991-1994. Observed/expected mortality was determined by linkage with cancer and mortality registries. Prostate cancer standardised mortality rate (SMR) in the overall series (751 subjects excluded by GPs for disabling illness or prostate cancer; 3,448 refusers, 2,662 attenders; 67,321.2 men-year) was 0.96 (95% confidence interval (CI)=0.74-1.22) when deaths from prevalent cancers diagnosed before screening were considered. Reduced prostate cancer mortality (SMR=0.48; 95% CI=0.26-0.83), persisting beyond five years after study entry (SMR=0.48; 95% CI=0.22-0.90), was observed in attenders and not in refusers (SMR=0.99; 95% CI=0.69-1.37). This finding might suggest a screening effect, but might also be ascribed to an healthy screening effect, and cannot be assumed as a reliable evidence of screening efficacy.
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Affiliation(s)
- Stefano Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Viale A. Volta 171, 50131 Firenze, Italy.
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Ciatto S, Gervasi G, Bonardi R, Frullini P, Zendron P, Lombardi C, Crocetti E, Zappa M. Determining overdiagnosis by screening with DRE/TRUS or PSA (Florence pilot studies, 1991-1994). Eur J Cancer 2005; 41:411-5. [PMID: 15691641 DOI: 10.1016/j.ejca.2004.09.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Revised: 09/09/2004] [Accepted: 09/28/2004] [Indexed: 11/30/2022]
Abstract
The rate of overdiagnosis of prostate carcinoma was assessed by following 6890 participants in pilot screening studies from 1991 to 1994. Observed/expected incidence and mortality were determined using data from the Cancer and Mortality Registry. The cancer detection rate (1.75%) and observed/expected ratio (12.5:1) were high at the first screening, and substantially lower at the second screening (0.65% or 4.10:1). According to the registry follow-up, prostate cancer occurred in 225 subjects in the whole study cohort, while 178.2 were expected with 50652 men/years at risk. The standardised incidence rate was 1.66 in the screened (95%CI=1.4-2.0), 0.97 in the non-responders (95%CI=0.8-1.2) and 1.23 in subjects excluded from invitation due to previous cancer or major illness (95%CI=0.8-1.5). A 66% excess incidence rate was observed in the screened subjects over a 9-year period, confirming previous estimates of overdiagnosis.
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Affiliation(s)
- Stefano Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Viale A. Volta 171, 50131 Florence, Italy.
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Ciatto S, Lombardi C, Rubeca T, Zappa M. Predictors of random sextant biopsy outcome in screened men with PSA > 4 ng/mL and a negative sextant biopsy at previous screening. Experience in a population-based screening program in Florence. Int J Biol Markers 2005; 19:89-92. [PMID: 15255539 DOI: 10.1177/172460080401900201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate possible pedictors of the outcome of repeat random sextant biopsy of the prostate prompted by a rise in prostate-specific antigen (PSA). Random biopsies performed for PSA elevation (>4 ng/mL) in the course of a randomized study of screening efficacy were reviewed, and 87 consecutive biopsies (carcinoma = 13, high-grade prostatic intraepithelial neoplasia = 6, negative = 68) performed in subjects with a negative random biopsy at the previous screening round were considered. Findings at digital rectal examination or transrectal ultrasonography and total PSA value were not useful predictors of repeat biopsy outcome, whereas PSA velocity was significantly associated with biopsy outcome. The positive predictive value for a cancer biopsy was 2.7% (1/36), 28.5% (2/7), and 22.7% (10/44) for PSA velocity values of <0.1, 0.1-0.19, and >0.19 ng/mL/yr, respectively. A cutoff of 0.1 ng/mL/yr for PSA velocity would have allowed to avoid approximately half (35/74 = 47.2%) of the benign biopsies while decreasing the sensitivity by 7.6% (1/13), and is thus suggested as a possible criterion for the indication of repeat random biopsy for persistent PSA elevation.
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Affiliation(s)
- S Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy.
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Roobol MJ, Schröder FH. European Randomized Study of Screening for Prostate Cancer: achievements and presentation. BJU Int 2004; 92 Suppl 2:117-22. [PMID: 14983969 DOI: 10.1111/j.1464-410x.2003.4698x.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ciatto S, Zappa M, Villers A, Paez A, Otto SJ, Auvinen A. Contamination by opportunistic screening in the European Randomized Study of Prostate Cancer Screening. BJU Int 2003; 92 Suppl 2:97-100. [PMID: 14983964 DOI: 10.1111/j.1464-410x.2003.04407.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S Ciatto
- Department Diagnostic Medical Imaging, Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy.
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Schröder FH, Denis LJ, Roobol M, Nelen V, Auvinen A, Tammela T, Villers A, Rebillard X, Ciatto S, Zappa M, Berenguer A, Paez A, Hugosson J, Lodding P, Recker F, Kwiatkowski M, Kirkels WJ. The story of the European Randomized Study of Screening for Prostate Cancer. BJU Int 2003; 92 Suppl 2:1-13. [PMID: 14983946 DOI: 10.1111/j.1464-410x.2003.04389.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F H Schröder
- Department of Urology, Erasmus Medical Centre, Rotterdam, the Netherlands.
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Ciatto S, Gervasi G, Frullini P, Zendron P, Zappa M. Specific features of the Italian section of the ERSPC. BJU Int 2003; 92 Suppl 2:30-2. [PMID: 14983951 DOI: 10.1111/j.1465-5101.2003.04394.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Ciatto
- Centro per lo Studio e lo Prevenzione Oncologica, Firenze, Italy.
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Ciatto S, Vis A, Finne P. How to improve the specificity and sensitivity of biopsy technique in screening. BJU Int 2003; 92 Suppl 2:79-83. [PMID: 14983961 DOI: 10.1111/j.1465-5101.2003.04403.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy.
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Ciatto S, Zappa M, Bonardi R, Gervasi G. Prostate cancer screening: the problem of overdiagnosis and lessons to be learned from breast cancer screening. Eur J Cancer 2000; 36:1347-50. [PMID: 10899646 DOI: 10.1016/s0959-8049(00)00119-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Screening for prostate cancer is a relatively new procedure, still under experimental evaluation within prospective randomised trials. The design of prospective studies has been mainly based on the experience of other cancer screenings, particularly breast cancer, for which data of several controlled studies are available. Unfortunately, breast cancer is very different from prostate cancer, particularly for aspects such as early diagnosis and, thus the screening process, originally modelled on the basis of the lesson taught by breast cancer screening, needs continuous re-evaluation and adjustment, based on data which are now being produced from ongoing screening experiences. In this paper, we will consider the most controversial aspects of prostate cancer screening and compare prostate screening with breast cancer screening in order to promote a better understanding of the current problems and lessons to be learned.
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Affiliation(s)
- S Ciatto
- Centro Studio Prevenzione Oncologica, Viale A. Volta, 171-I-50131, Firenze, Italy.
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Zappa M, Ciatto S, Bonardi R, Mazzotta A. Overdiagnosis of prostate carcinoma by screening: an estimate based on the results of the Florence Screening Pilot Study. Ann Oncol 1998; 9:1297-300. [PMID: 9932159 DOI: 10.1023/a:1008492013196] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To estimate overdiagnosis (detection of latent carcinomas) as a consequence of screening for prostate cancer. DESIGN Based on actual screen (first or repeat) detected and interval prostate cancer rates observed in the Florence screening pilot study, a scenario was simulated where males aged 60 years (or 65) had six biennal screens and were followed up for four years. Overdiagnosis was determined as the proportional excess of cancers detected by screening with respect to that expected in its absence. SETTING City of Florence, Italy, from 1992 through 1995. POPULATION 2,740 resident males, aged 60 to 74 years. RESULTS Overdiagnosis was estimated to be 51% (95% confidence limits: 44%-55%) or 93% (85%-101%) for age 60 or 65 at entry. Comparison with other screening experiences obtaining higher detection rates suggests that a more aggressive screening approach could be associated with overdiagnosis estimates as big as 200%-250%. CONCLUSIONS Screening for prostate cancer is associated with a relevant risk of overdioagnosis. As latent carcinomas can not be presently identified, this would lead to overtreatment in most overdiagnosed cases. The negative consequences of overdiagnosis (knowledge of having a cancer) and of overtreatment (impotence, incontinence, perioperatory death) may be extremely serious. In absence of any scientific evidence of screening benefits (if any) screening should not be recommended as a current practice, but should be limited to prospective controlled studies designed to assess its cost-effectiveness.
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Affiliation(s)
- M Zappa
- Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy
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Ferrini R, Woolf SH. American College of Preventive Medicine practice policy. Screening for prostate cancer in American men. Am J Prev Med 1998; 15:81-4. [PMID: 9651646 DOI: 10.1016/s0749-3797(98)00050-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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