PSA-use in a Spanish industrial area

[Prostate cancer screening with Prostate-Specific Antigen (PSA) to men over 70 years old in an urban health zone, 2018-2020: A cross-sectional study]

OBJECTIVES

To describe the epidemiology and estimate the cost of Prostate-Specific Antigen (PSA) screening tests to men ≥ 70 years old in an urban health zone.

METHODS

A cross-sectional study was performed. We obtained every PSA test made in the health zone from 2018 to 2020, and classified them retrospectively as screening (PSAc) or not according to pre-established criteria, reviewing electronic health records. Testing rates were calculated by centres and clinical specialities. The standard population was provided by the city register of inhabitants (VM70). Cost estimation was made using our health system's price list.

RESULTS

Two thousand and thirty six PSA, of 888 men ≥ 70 years old were obtained, and 350 met screening classification criteria. Six adenocarcinomas were diagnosed from those tests. We estimated 76.07 PSAc/1000 VM70-year from any centre, 1.45 tests for each screened individual, and 15.71% prevalence. The standard population was 1534 men (mean 2018-2020, SD 45.37). Patients who were screened (median age 75, SD 4.04) were younger than those not screened. We estimated a total screening test cost of 9,751 €.

CONCLUSIONS

The epidemiology and cost of PSA screening tests to men ≥ 70 years old are reported, both in primary health care and in the hospital. PSA screening tests are common practice amongst professionals attending elderly men in our health zone, mostly in primary care. The screening testing rate of men without prostate cancer is similar to that reported in the literature.

Long-term prostate-specific antigen contamination in the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC)

OBJECTIVES

Recently, the European Randomized Study of Screening for Prostate Cancer achieved a reduction in prostate cancer mortality by measuring serum prostate-specific antigen (PSA) levels. These results were not reproduced in the Spanish arm of European Randomized Study of Screening for Prostate Cancer. PSA contamination (opportunistic measurements outside the study) could decrease the study's contrasting power if performed in the control arm. We have calculated the long-term rate of PSA contamination and its effect on performing prostate biopsy and detecting cancer.

MATERIAL AND METHODS

A total of 4,276 men were randomised (2,415 to the screening arm, 1,861 to the control arm) in the Spanish section of the European Randomized Study of Screening for Prostate Cancer. PSA measurements were not scheduled in the control arm. Sextant prostate biopsy was indicated if PSA levels were ≥3 ng/mL. All PSA readings performed outside the study were labelled as "PSA contamination". We calculated the rates of PSA contamination, biopsy implementation and cancer detection.

RESULTS

The median age and follow-up time were 57 and 15.1 years, respectively. A total of 2,511 men underwent at least one PSA reading outside the study. PSA contamination at 5, 10 and 15 years was 22.0%, 47.1% and 66.3% in the screening arm, respectively, and 20.8%, 43.2% and 58.6% in the control arm, respectively (P<.0001). The biopsy rate at 5, 10 and 15 years was 19.3%, 22.6% and 24.1% (screening), respectively, and 1.0%, 3.6% and 7.1% (control), respectively (P<.0001). The PC detection rate was 6.7% (screening) and 4.3% (control; P=.0006).

CONCLUSIONS

Although the cumulative PSA contamination was pronounced in the 2 study arms, the rate of prostate biopsies was low in the control arm. We therefore believe that the effect of PSA contamination on the study's statistical power should be limited.

Breast and prostate cancer: an analysis of common epidemiological features in mortality trends in Spain

BACKGROUND

Breast cancer in women and prostate cancer are the first and second leading tumour respectively in terms of incidence world-wide. Our objective is to ascertain the similarities and differences between mortality trends in breast cancer among women and prostate cancer in Spain using age-period-cohort models, and analyse the correlation between incidence of breast and prostate cancer at cancer registries locally and world-wide.

METHODS

We analysed the independent effects of age, period of death and birth cohort on mortality rates for breast cancer in women and prostate cancer in Spain across the period 1952-2011. Segmented regression analyses were performed to detect and estimate changes in period and cohort curvatures. Correlation among age-adjusted incidence rates at 246 population cancer registries world-wide was analysed for the period 2003-2007.

RESULTS

The mortality trend displayed common characteristics in terms of the annual number of deaths due to these tumours, their adjusted mortality rates and the change points detected in the cohort and period effects. The trend in incidence was very different to that in mortality, due to early detection and progressive improvement in survival. Correlation between the incidence rates of both tumours recorded by registries around the world proved to be a generalised phenomenon.

CONCLUSIONS

This study shows that breast cancer mortality in women and prostate cancer mortality and their trends in Spain display visible similarities in terms of the number of deaths due to these tumours, their adjusted mortality rates and the changes experienced by mortality over time. The effects of advances in the diagnosis of both tumours correspond to a decline in mortality which becomes evident after a lag of approximately eight years. Correlation between breast and prostate cancer incidence rates is very high in Spain and at registries on all continents.

Prediagnostic concentrations of plasma genistein and prostate cancer risk in 1,605 men with prostate cancer and 1,697 matched control participants in EPIC

PURPOSE

Data from prospective epidemiological studies in Asian populations and from experimental studies in animals and cell lines suggest a possible protective association between dietary isoflavones and the development of prostate cancer. We examined the association between circulating concentrations of genistein and prostate cancer risk in a case-control study nested in the European Prospective Investigation into Cancer and Nutrition.

METHODS

Concentrations of the isoflavone genistein were measured in prediagnostic plasma samples for 1,605 prostate cancer cases and 1,697 matched control participants. Relative risks (RRs) for prostate cancer in relation to plasma concentrations of genistein were estimated by conditional logistic regression.

RESULTS

Plasma genistein concentrations were not associated with prostate cancer risk; the multivariate relative risk for men in the highest fifth of genistein compared with men in the lowest fifth was 1.00 (95 % confidence interval: 0.79, 1.27; p linear trend = 0.82). There was no evidence of heterogeneity in this association by age at blood collection, country of recruitment, or cancer stage or histological grade.

CONCLUSION

Plasma genistein concentration was not associated with prostate cancer risk in this large cohort of European men.

Animal foods, protein, calcium and prostate cancer risk: the European Prospective Investigation into Cancer and Nutrition

We examined consumption of animal foods, protein and calcium in relation to risk of prostate cancer among 142 251 men in the European Prospective Investigation into Cancer and Nutrition. Associations were examined using Cox regression, stratified by recruitment centre and adjusted for height, weight, education, marital status and energy intake. After an average of 8.7 years of follow-up, there were 2727 incident cases of prostate cancer, of which 1131 were known to be localised and 541 advanced-stage disease. A high intake of dairy protein was associated with an increased risk, with a hazard ratio for the top versus the bottom fifth of intake of 1.22 (95% confidence interval (CI): 1.07-1.41, P(trend)=0.02). After calibration to allow for measurement error, we estimated that a 35-g day(-1) increase in consumption of dairy protein was associated with an increase in the risk of prostate cancer of 32% (95% CI: 1-72%, P(trend)=0.04). Calcium from dairy products was also positively associated with risk, but not calcium from other foods. The results support the hypothesis that a high intake of protein or calcium from dairy products may increase the risk for prostate cancer.

Serum androgens and prostate cancer among 643 cases and 643 controls in the European Prospective Investigation into Cancer and Nutrition

We examined the hypothesis that serum concentrations of circulating androgens and sex hormone binding globulin (SHBG) are associated with risk for prostate cancer in a case-control study nested in the European Prospective Investigation into Cancer and Nutrition (EPIC). Concentrations of androstenedione, testosterone, androstanediol glucuronide and SHBG were measured in serum samples for 643 prostate cancer cases and 643 matched control participants, and concentrations of free testosterone were calculated. Conditional logistic regression models were used to calculate odds ratios for risk of prostate cancer in relation to the serum concentration of each hormone. After adjustment for potential confounders, there was no significant association with overall risk for prostate cancer for serum total or free testosterone concentrations (highest versus the lowest thirds: OR, 1.02; 95% CI, 0.73-1.41 and OR, 1.07, 95% CI, 0.74-1.55, respectively) or for other androgens or SHBG. Subgroup analyses showed significant heterogeneity for androstenedione by cancer stage, with a significant inverse association of androstenedione concentration and risk for advanced prostate cancer. There were also weak positive associations between free testosterone concentration and risk for total prostate cancer among younger men and risk for high-grade disease. In summary, in this large nested case-control study, concentrations of circulating androgens or SHBG were not strongly associated with risk for total prostate cancer. However, our findings are compatible with a positive association of free testosterone with risk in younger men and possible heterogeneity in the association with androstenedione concentration by stage of disease; these findings warrant further investigation.

Plasma carotenoids, retinol, and tocopherols and the risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition study

BACKGROUND

Previous studies suggest that high plasma concentrations of carotenoids, retinol, or tocopherols may reduce the risk of prostate cancer.

OBJECTIVE

We aimed to examine the associations between plasma concentrations of 7 carotenoids, retinol, alpha-tocopherol, and gamma-tocopherol and prostate cancer risk.

DESIGN

A total of 137,001 men in 8 European countries participated. After a mean of 6 y, 966 incident cases of prostate cancer with plasma were available. A total of 1064 control subjects were selected and were matched for study center, age, and date of recruitment. The relative risk of prostate cancer was estimated by conditional logistic regression, which was adjusted for smoking status, alcohol intake, body mass index, marital status, physical activity, and education level.

RESULTS

Overall, none of the micronutrients examined were significantly associated with prostate cancer risk. For lycopene and the sum of carotenoids, there was evidence of heterogeneity between the associations with risks of localized and advanced disease. These carotenoids were not associated with the risk of localized disease but were inversely associated with the risk of advanced disease. The risk of advanced disease for men in the highest fifth of plasma concentrations compared with men in the lowest fifth was 0.40 (95% CI: 0.19, 0.88) for lycopene and 0.35 (95% CI: 0.17, 0.78) for the sum of carotenoids.

CONCLUSIONS

We observed no associations between plasma concentrations of carotenoids, retinol, or tocopherols and overall prostate cancer risk. The inverse associations of lycopene and the sum of carotenoids with the risk of advanced disease may involve a protective effect, an association of dietary choice with delayed detection of prostate cancer, reverse causality, or other factors.

Incidencia del cáncer urológico en un área sanitaria de 300.000 habitantes

OBJECTIVE

To provide descriptive information on site-specific urological cancer occurrence we computed 10-year cancer incidence rates in the geographic area of Getafe (Madrid, Spain, 300,000 people).

MATERIALS AND METHODS

Only histologically confirmed genitourinary cancer (bladder, prostate, kidney, testicle and penis) throughout 1992-2001 was considered. Cancers were classified according to the international rules. 10 years age-standardized population-adjusted incidence rates per 100,000 people (or per 100,000 men when appropriate) were calculated. Overall and cancer-specific yearly increments were also evaluated. The most recent release of National Statistics (2001) was used for population adjusting.

RESULTS

Prostate cancer (PC) accounted for the majority of diagnostics. A strong correlation was detected between the total number of new cancer diagnostics and the overall population. While the correlation was frail between the number of new cancer diagnostics in females and the female population, the association remained significant in males. Nevertheless, only the number of new prostate cancer diagnostics was firmly and significantly associated with the population.

CONCLUSIONS

Incidence rates of every cancer type increased throughout the last decade. Nevertheless, this increases didn't parallel the population increment perhaps translating environmental factors.

The Spanish contribution to the European Randomized Study of Screening for Prostate Cancer

OBJECTIVE

To summarize the experience of the Spanish participation in the European Randomized Study of Screening for Prostate Cancer (ERSPC).

METHODS

In this study men aged 45-70 years were randomized (1:1) and allocated to one of two arms: screening, with an indication for transrectal ultrasonography (TRUS) and sextant prostate biopsy when the serum prostate-specific antigen (PSA) level was >4 ng/mL (until May 1998) and from then when the PSA was >2.9 ng/mL; and a control group (no diagnostic tests). The findings from a digital rectal examination were not considered as a criterion for biopsy. When the serum PSA was above the threshold levels, biopsy-negative men were invited again after a year ('early recall'). The next (second) screening round was programmed for the rest of participants after a 4-year interval. Cancer-specific mortality was recorded and compared in both groups.

RESULTS

In all, 4278 men were recruited (2416 in the screening group and 1862 in the control group). The recruitment phase was closed in June 1999. During the first screening round 40 cancers were detected; the detection rate was then 1.7% and 4.15 biopsies were needed to detect each cancer. The clinical stage was localized in 88.6% and regional or metastatic in 11.4%. Within the first round, 17 more cancers were detected at early recall attendance. During the second screening round 14 cancers were found, giving a detection rate of 1.9%; 17 more cancers were also diagnosed outside the screening programme (contamination), seven in the screening group and 10 in the control group. Until February 2003, 85 participants had died (53 screened and 32 control) but none from prostate cancer.

CONCLUSIONS

Cancer detection rates can be increased with further early recalls; the clinical stage was localized in an important proportion of cancers detected.

Screening for prostate cancer: have you had your cholesterol measured?

Screening for prostate cancer has become one of the most common topics of conversation at urological oncology meetings. Most people have a bias as to whether there should or should not be a national screening programme. Unfortunately there are many unanswered questions, which may or may not be possible to answer definitively. In a balanced and scholarly review of the subject, Professor Peter Boyle indicates several flaws in the agreement for screening, but feels that PSA testing will continue unabated. The authors from the University of Stellenbosch review the plentiful literature relating to testicular torsion and functional recovery. They also review the mechanism of injury and the effect on the contralateral testis.

Effective PSA contamination in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer

The extent of effective prostate-specific antigen (PSA) contamination in the Rotterdam section of the ongoing European Randomized Study of Screening for Prostate Cancer (ERSPC) trial was evaluated and defined as when opportunistic PSA testing of >/= 3.0 ng/ml was followed by biopsy, similar to the regular procedure within the trial. Records of participants aged 55-74 years at entry were linked to the regional database of the general practitioner (GP) laboratory to obtain PSA tests requested by GPs in the period 1 July 1997 to 31 May 2000 (2.9 years), and to the national pathology database to quantify the number of biopsies. All men randomized were included, only those with prostate cancer screen-detected or clinically diagnosed before July 1997 were omitted from the analyses. 2,895 out of the 14,349 men (20.2%) in the control arm and 1,981 out of the 14,052 men (14.1%) in the screening arm were PSA-tested, at an average annual rate of 73 and 52 per 1,000 person-years, respectively. These rates were higher than those recorded at the national and regional levels, 33 and 38 per 1,000 person-years, respectively. Opportunistic PSA testing in the control arm reached a peak within the first months of randomization, after which it decreased to around 70 per 1,000 person-years. An opposite pattern was observed in the screening arm, where participants already had received the scheduled screening within the trial. The proportion of men in the control arm with PSA >/= 3.0 ng/ml followed by biopsy and prostate cancer was 7-8% and 3%, respectively (3% and 0.4-0.6% in the screening arm), over the whole study period. Over a 4-year rescreening interval, the average PSA and effective contamination amount were approximately 28% and 10%, respectively. PSA testing in the control arm in the Rotterdam ERSPC section is high, but was not followed by a substantial increase in prostate biopsies. Although the reasons for ordering PSA test or indicating biopsy are unknown, effective PSA contamination in the Rotterdam ERSPC section is low and not likely to jeopardize the power of the trial.