Prostate Cancer Detection And Screening Session I - AUA 2006

UroToday.com - A Podium Session on Prostate Cancer Detection and Screening took place on Sunday May 21, 2006 at the annual AUA meeting in Atlanta. Some highlights from the 12 papers presented are as follows.

Dr. Ian Thompson, San Antonio, TX reported on ability for PSA to detect CaP in finasteride treated patients. Patients in the PCPT study who were on placebo or finasteride and underwent prostate biopsy were evaluated. Receiver operator characteristic curves (ROC) were calculated for the presence and absence of CaP and Gleason score. Of the 5,112 men in the placebo group, 1,111 were diagnosed with CaP compared to 695 of 4,579 men in the finasteride group. The area under the ROC curve was greater for finasteride than placebo. This was true for cancer detection overall and for high-grade disease. This study suggests a bias toward increased detection of CaP and high-grade CaP in men treated with finasteride in the PCPT study.

Dr. Loeb, Washington, DC stated that a PSA velocity (PSAV) of 0.5ng/ml/year should be used in men under age 60. Using the database of Dr. Catalona, 6,844 men under age 60 were identified and 346 of these were diagnosed with CaP. Analysis of their PSAV showed that a PSAV >0.5ng/ml/year was more predictive of CaP than age, total PSA, family history or race. Even those men with a PSA <0.25ng/ml had similar results. The sensitivity, specificity and positive and negative predictive values were 62%, 85%, 18%, and 98%, respectively.

Dr. Georg Bartsch, Innsbruck Austria and colleagues in several other countries presented an update on the Tyrolean CaP screening study. The program using PSA has been in place since 1993. Men diagnosed with CaP could go on to radical prostatectomy. Migration to lower stage of CaP and an increase in the number of organ-confined tumors was observed since the start of the program. A reduction in the mortality rates was observed in Tyrol and the rest of Austria (where PSA screening was not introduced). Dr. Bartsch concluded that the decline in death is likely a result of downstaging through surgical curable disease and successful treatment.

A presentation from Dr. Alschibaja, Munich Germany suggests that clinically insignificant CaP cannot be reliably predicted. A cohort of 349 patients undergoing radical prostatectomy had pathology specimens analyzed. Of these, 38 (9.2%) met the criteria for insignificant CaP. The model generated had a sensitivity of 84.2% and a specificity of 90.4%. The positive predictive value was only 51.5%, suggesting that 9.4% of clinically significant tumors would be missed.

By Christopher P. Evans, M.D.

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