Detection of Prostate Cancer in Unselected Young Men: Prospective Cohort Nested within a Randomised Controlled Trial - Abstract

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Wednesday, 02 January 2008

Department of Social Medicine, University of Bristol

To investigate the feasibility of testing for prostate cancer and the

prevalence and characteristics of the disease in unselected young men.

Prospective cohort nested within a randomised controlled trial, with two

years of follow-up.

Eight general practices in a UK city.

1299 unselected men aged 45-49.

Prostate biopsies for participants with a prostate specific antigen level of

1.5 ng/ml or more and the possibility of randomisation to three treatments

for those with localised prostate cancer.

Uptake of testing for prostate specific antigen; positive predictive value

of prostate specific antigen; and prevalence of prostate cancer, TNM disease

stage, and histological grade (Gleason score).

442 of 1299 men agreed to be tested for prostate specific antigen (34%) and

54 (12%) had a raised level. The positive predictive value for prostate

specific antigen was 21.3%. Ten cases of prostate cancer were detected

(2.3%) with eight having at least two positive results in biopsy cores and

three showing perineural invasion. One tumour was of high volume (cT2c),

Gleason score 7, with a positive result on digital rectal examination; nine

tumours were cT1c, Gleason score 6, and eight had a negative result on

digital rectal examination. Five of the nine eligible participants (55%)

agreed to be randomised. No biochemical disease progression in the form of a

rising prostate specific antigen level occurred in two years of follow-up.

Men younger than 50 will accept testing for prostate cancer but at a much

lower rate than older men. Using an age based threshold of 1.5 ng/ml, the

prevalence of prostate cancer was similar to that in older men (3.0 ng/ml

threshold) and some cancers of potential clinical significance were found.

TRIAL REGISTRATION: Current Controlled Trials ISRCTN20141297.

Written by

Lane JA, Howson J, Donovan JL, Goepel JR, Dedman DJ, Down L, EL, Neal

DE, Hamdy FC.

Reference

BMJ. 2007 Dec 1;335(7630):1139. Epub 2007 Nov 15

doi:10.1136/bmj.39381.436829.BE

PubMed Abstract

PMID:18006969

C. Meade

 

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