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Screening for Prostate Cancer: Current Status of ERSPC and Screening-Related Issues

  • Fritz H. SchröderEmail author
Chapter
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 202)

Abstract

The “European Randomized Study of Screening for Prostate Cancer” (ERSPC) was initiated in 1993 and up to 1998 six other European countries were joined. The main goal is to establish the effect of Prostate Specific Antigen (PSA)-based screening on prostate cancer (PCa) mortality with morbidity as secondary end point. At present, with 11 and 12 years of follow-up significant relative reductions of 21 % and 31 % relating to both end points have been reported. The diagnosis of non-life threatening PCA (over diagnosis) is estimated to be in the range of 50 % and represents the main “harm”, which prevents the introduction of population-based screening. As a result, the prevention of over diagnosis is now given top research priority. PSA as a screening test has poor performance characteristics including a low specificity. With the cut-off value of 3.0 ng/ml chosen within ERSPC, about 25 % of men aged 55--69 test positively, 75 % have “negative” test results, which do not definitely exclude the presence of PCa. Research to establish empirical schemes of follow-up based on PSA levels and other parameters are ongoing worldwide. In the meantime, we are, by approximation, capable to identify over diagnosed PCa detected by screening. Active surveillance can be applied to avoid side effects and expenses of treatment and is, among others, based on the grade of differentiation determined on biopsies. The assignment of the most favorable “Gleason score 6” is a crucial decision element. Unfortunately, biopsy pathology underestimates the true degree of PC aggressiveness by 25--30 % which establishes the need of careful follow-up.

Keywords

Prostate Cancer Prostate Specific Antigen Prostate Cancer Death Elevated Prostate Specific Antigen Significant Prostate Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Draisma G et al (2006) Gleason score, age and screening: modelling dedifferentiation in prostate cancer. Int J Cancer 119(10):2366–2371PubMedCrossRefGoogle Scholar
  2. Heijnsdijk AM et al (2012) Quality-of-life effects of prostate-specific antigen screening. N Engl J Med 367(7):595–605PubMedCrossRefGoogle Scholar
  3. Schröder FH et al (2012a) Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 366:981–990CrossRefGoogle Scholar
  4. Schröder FH et al (2012b) Screening for prostate cancer decreases the risk of developing metastatic disease: findings from the European randomized study of screening for prostate cancer (ERSPC). Eur Urol 62(5):745–752CrossRefGoogle Scholar
  5. Zhu X et al (2011) Identifying and characterizing ‘escapes’-men who develop metastases or die from prostate cancer despite screening (ERSPC, section Rotterdam). Int J Cancer 129(12):2847–2854PubMedCrossRefGoogle Scholar
  6. Zhu X et al (2013) Disease-specific survival of men with screen-detected prostate cancer: comparison of first round versus second round cancers in a European randomized screening trial. EAU, Milan. abstract nr. 5Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of UrologyErasmus University Medical CenterRotterdamNetherlands

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