Huggins Award Given To Dr. Fritz Schroeder, Erasmus University - Screening Of Prostate Cancer In The ERSPC (European Randomized Screening Of Prostate

UroToday.com - Dr. Fritz Schroeder, Erasmus University presented the Huggins Award Lecture on the Screening of Prostate Cancer in the ERSPC (European Randomized Screening of Prostate Cancer), Rotterdam series. Endpoints of the trial include CaP mortality, morbidity, QoL, and QoL adjusted life years. In December 2006, a second interim analysis was performed and the data is yet unknown.

267,994 patients were randomized beginning in 1994 and 23,794 men have died to date. 6,033 cases of CaP were detected and of those 30% died of CaP. Overall, 6.6% of all enrolled have died of CaP. Dr. Schroeder stated that the main endpoint of the trial should be reached in 2008 to 2010. One expectation is that an approximately 25% mortality will be appreciated through screening. This would lead to a recommendation that screening be widely utilized. On the other hand, Dr. Schroeder pointed out that this might result in the over-diagnosis and over-treatment of low-risk disease.

He then focused on the over-diagnosis of CaP. Studies have suggested that this occurs in 51% of men age 60. In a study by Kattan (2003), 20% of cases treated by RP were deemed "indolent". In the ERSPC, Rotterdam series, however, 49% were deemed indolent and this may reflect the difference between those that were screen detected. One-third of screen detected prostate cancers can be identified as "indolent", he concluded. The screening process also results in CaP lead-time detection bias of 10.8 years according to the Rotterdam data.

Dr. Schroeder then discussed the PSA dilemma. Using PSA cutoffs of 4.0ng/ml and 2.0ng/ml as indications for biopsy would result in missing 75% and 45% of biopsy detectable CaP, respectively. He then examined interval CaP in men with a PSA <3 at first screen who were found to have CaP on round 2 screening. Ten percent of men (1,090) were found to have a PSA above 3ng/ml on 2nd round. 275 of these had CaP. 106/275 had RP with 16 (15%) having subsequent PSA progression. 18/105 who had radiotherapy (17%) had PSA progression after treatment. He concluded that 30% of overtreatment can be identified and low PSA range patients can have delayed treatment. He recommended using a cutpoint of 2.0ng/ml and then using algorithms of risk factors and shorter interval for men with a PSA of 2-4ng/ml.

Report from The Society of Urologic Oncology Winter Meeting - National Institutes of Health - December 1-2, 2006
Reviewed by UroToday.com Contributing Editor Christopher P. Evans, M.D

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