Marco Randazzo1, Josef Beatrice2, Andreas Huber3, Rainer Grobholz4, Lukas Manka5, Felix K Chun6, Franz Recker2, Maciej Kwiatkowski7. 1. Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland. Electronic address: marco_randazzo1@hotmail.com. 2. Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland. 3. Department of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland. 4. Department of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland. 5. Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany. 6. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 7. Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland; Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
Abstract
BACKGROUND: In daily routine business, various prostate-specific antigen (PSA) retest strategies are being promoted. OBJECTIVE: To investigate rescreening intervals according to baseline PSA <3 ng/ml stratified by any and aggressive prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS: From 1998 to 2012, data from 4350 men aged 55-70 yr were analyzed from a population-based prospective screening study (median follow-up: 11.6 yr). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary end point was detection of aggressive PCa (Gleason score 7-10). Cox regression analysis was used to examine the relationship between covariates. RESULTS AND LIMITATIONS: Baseline PSA of <1.0 ng/ml, 1-1.9 ng/ml, and 2-2.9 ng/ml was present in 2416 men (55.5%: group 1), 1371 men (31.6%: group 2), and 563 men (12.9%: group 3), respectively. Stratified according to these PSA groups, aggressive PCa was detected in 25 patients (1.0%), 80 patients (5.8%), and 34 patients (6.0%), respectively. During 4 yr, these numbers were 0.0%, 0.29%, and 1.8%, whereas during 8 yr, the numbers were 0.2%, 1.4%, and 2.5%, respectively. In multivariable Cox regression analysis, the only independent risk factor for aggressive PCa was baseline PSA (hazard ratio [HR]: 6.06; 95% confidence interval [CI], 3.82-9.61; p<0.0001, group 2 vs group 1; and HR: 7.33; 95% CI, 4.29-12.52; p<0.0001, group 3 vs group 1). CONCLUSIONS: Baseline PSA was the only predictor regarding aggressive PCa. According to the low rate of potentially missed PCa in these groups, rescreening intervals can be safely adapted to baseline PSA values corresponding to a "PSA pyramid": 6-8 yr if baseline PSA is <1.0 ng/ml, 3-4 yr if baseline PSA is 1-1.99 ng/ml, and yearly if baseline PSA is 2-2.99 ng/ml. PATIENT SUMMARY: We observed men with a prostate-specific antigen (PSA) value ≤3 ng/ml during 12 yr and found that men can be retested according to their initial PSA value ("PSA pyramid"): PSA <1 (base), retest interval every 8 yr; PSA 1-2 (center), retest interval every 4 yr; and PSA 2-3 (top), retest yearly after risk stratification.
RCT Entities:
BACKGROUND: In daily routine business, various prostate-specific antigen (PSA) retest strategies are being promoted. OBJECTIVE: To investigate rescreening intervals according to baseline PSA <3 ng/ml stratified by any and aggressive prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS: From 1998 to 2012, data from 4350 men aged 55-70 yr were analyzed from a population-based prospective screening study (median follow-up: 11.6 yr). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary end point was detection of aggressive PCa (Gleason score 7-10). Cox regression analysis was used to examine the relationship between covariates. RESULTS AND LIMITATIONS: Baseline PSA of <1.0 ng/ml, 1-1.9 ng/ml, and 2-2.9 ng/ml was present in 2416 men (55.5%: group 1), 1371 men (31.6%: group 2), and 563 men (12.9%: group 3), respectively. Stratified according to these PSA groups, aggressive PCa was detected in 25 patients (1.0%), 80 patients (5.8%), and 34 patients (6.0%), respectively. During 4 yr, these numbers were 0.0%, 0.29%, and 1.8%, whereas during 8 yr, the numbers were 0.2%, 1.4%, and 2.5%, respectively. In multivariable Cox regression analysis, the only independent risk factor for aggressive PCa was baseline PSA (hazard ratio [HR]: 6.06; 95% confidence interval [CI], 3.82-9.61; p<0.0001, group 2 vs group 1; and HR: 7.33; 95% CI, 4.29-12.52; p<0.0001, group 3 vs group 1). CONCLUSIONS: Baseline PSA was the only predictor regarding aggressive PCa. According to the low rate of potentially missed PCa in these groups, rescreening intervals can be safely adapted to baseline PSA values corresponding to a "PSA pyramid": 6-8 yr if baseline PSA is <1.0 ng/ml, 3-4 yr if baseline PSA is 1-1.99 ng/ml, and yearly if baseline PSA is 2-2.99 ng/ml. PATIENT SUMMARY: We observed men with a prostate-specific antigen (PSA) value ≤3 ng/ml during 12 yr and found that men can be retested according to their initial PSA value ("PSA pyramid"): PSA <1 (base), retest interval every 8 yr; PSA 1-2 (center), retest interval every 4 yr; and PSA 2-3 (top), retest yearly after risk stratification.
Authors: Anna Grenabo Bergdahl; Ulrica Wilderäng; Gunnar Aus; Sigrid Carlsson; Jan-Erik Damber; Maria Frånlund; Kjell Geterud; Ali Khatami; Andreas Socratous; Johan Stranne; Mikael Hellström; Jonas Hugosson Journal: Eur Urol Date: 2015-12-24 Impact factor: 20.096
Authors: Maciej Kwiatkowski; Marco Randazzo; Luis Kluth; Lukas Manka; Andreas Huber; Franz Recker Journal: Asian J Androl Date: 2015 May-Jun Impact factor: 3.285