Study: Tighter criteria for aggressive PCa screening warranted

In men with a low serum baseline PSA level, the benefits of additional screening or treatment appear to be limited, European researchers reported.

Study authors from Erasmus Medical Center, Rotterdam, the Netherlands say that their data indicate which groups of men should receive aggressive screening, suggesting the criteria for screening and early diagnosis can be tightened.

"Unlike previous studies, we have been successful in identifying not only the groups of men who would relatively benefit most from screening and early detection, but also the men for whom the pros of screening and early detection do not appear to outweigh the cons," said first author Pim van Leeuwen, MD.

Between 1993 and 1999, 43,987 men, aged 55 to 74 years, were included in the intervention arm of the European Randomized Study of Screening for Prostate Cancer section in the Netherlands, Sweden, and Finland. A total of 42,503 men, aged 55 to 74 years, were included in a clinical population in Northern Ireland. Serum PSA

For men with a PSA value between 0.1 and 1.9 ng/mL, the disadvantages of repeated screening were substantially larger than the advantages. In this group, 24,642 men would have to be examined in the course of the first 9 years after the start of the screening to save one man from death from prostate cancer, and 724 men would have to undergo treatment unnecessarily, Dr. van Leeuwen and colleagues reported.

On the other hand, in men with a PSA value between 4.0 and 10.0 ng/mL or between 10.0 and 20.0 ng/mL, the advantages of repeated screening appear to outweigh the disadvantages. Only 133 men would need to be screened to prevent one death as a result of prostate cancer.

"On the basis of these results, we can come to the conclusion that for the time being, it would be advisable to exercise restraint in constantly re-examining men with a low PSA value," Dr. van Leeuwen said.

Study results were published online in Cancer (Sept. 13, 2010).