PROSTATE-SPECIFIC ANTIGEN AS A SCREENING TEST : The Austrian Experience - 11/09/11
Résumé |
Several studies have shown prostate-specific antigen (PSA)–based screening to be the most effective screening test for the detection of prostate cancer, although most studies were done in men referred to urologic care settings because of signs and symptoms.2, 4, 8 It is only recently that large screening studies in asymptomatic men in a large population and during a limited time frame have been conducted.7 A mass screening project was conducted in the country of Tirol. Tirol, one of nine countries of the republic of Austria, is an alpine area in the western part of Austria with 631,410 inhabitants (324,161 women, 307,249 men) and an area of 12,647 km2. The major part of this area is formed by valleys and mountains, and the distances to the capital Innsbruck, where the central medical supply is located, are not too far. This geographic situation, as well as the general readiness of the Tyrolean population for general preventive medicine, caused us to establish a country-wide mass screening program with PSA as the initial test for early detection of prostate cancer. Of 307,249 male inhabitants, 65,000 men are between the ages of 45 and 74 years. We recommended that men within this age range should undergo screening. Screening information was distributed to all Tyrolean men by press, radio, and television.
This screening project was done in collaboration with general practitioners, medical officers, urologists, and the Red Cross Blood Bank of the country of Tirol. All medical coworkers were fully informed about the management of blood withdrawal, storage, and posting. After the arrival of the blood or serum sample the PSA measurement was done immediately. Each screening volunteer or the assigning medical doctor was informed in writing about the PSA result. In case of PSA elevation the screening volunteers were invited to undergo further urologic evaluation, and all men with a normal PSA level were invited to repeat PSA testing 1 year later.
This mass screening project lasted 1 year and was free of charge. We recommended that men 45 to 75 years old should undergo screening. We did not, however, exclude men in their early forties and men older than 76 from screening, so as not to discriminate against men who desired examination in this manner. Data from those men were not included in the study protocol.
Between October 1993 and September 1994 about 65,000 Tyrolean men 45 to 75 years old were invited to participate in this prostate cancer screening study with PSA as the initial screening test. 21,078 male volunteers (30%) responded to the press, radio, and TV release asking healthy men to participate in a study of PSA measurement as a screening test for prostate cancer. None had a history of prostate cancer, and those with a history of prostatitis were excluded.
All men underwent determination of serum PSA concentration (Abbott IMX assay, Abbott Park, IL) in one laboratory. We suggested the use of age-related PSA levels. Age-specific referenced PSA levels were defined according to Oesterling et al's12 recommendation that the normal level should be 2.5 ng/mL in men aged 40 to 49 years, 3.5 ng/mL in men aged 50 to 59, 4.5 ng/mL in men aged 60 to 69, and 6.5 ng/mL in men aged 70 to 79. Age was defined as the subject's age on the day of the PSA assessment. All men with an elevated PSA according to age-specific referenced ranges were invited to undergo further urologic evaluation with digital rectal examination and ultrasound-guided biopsies. Digital rectal examination and transrectal ultrasound were done by the same four urologists. Ultrasonography, using three-dimensional Kretz ultrasound equipment was performed in three planes (sagittal, horizontal, and coronal), and biopsies were done under ultrasound guidance with an automatic biopsy gun and an 18-gauge needle (sextant biopsy). If cancer was detected, clinical staging in asymptomatic men with a PSA serum concentration less than 10 ng/mL consisted of a digital rectal examination, chest radiography, and three-dimensional transrectal ultrasound of the prostate. Only in patients with PSA levels higher than 10 ng/mL were CT of the pelvis and a radionuclide bone scan performed. The tumor was classified as organ-confined if it was judged to be confined to the prostate and as advanced if it extended beyond the capsule. Patients with clinically organ-confined disease and no medical contraindication to major surgery were subjected to radical prostatectomy. Pathologic staging was defined as organ-confined (stages pT1 and pT2), tumors extending through the prostatic capsule and positive margins (stage pT3), tumors with unilateral (stage pT3a) or bilateral (pT3b) extracapsular extension, tumors invading the seminal vesicles (pT3c), and regional lymph node metastases (N+). Tumor grading was done according to the Gleason score system.
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| Address reprint requests to Andreas Reissigl, MD, Department of Urology, University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria |
Vol 24 - N° 2
P. 315-321 - mai 1997 Retour au numéro
Article précédent
- PROSTATE-SPECIFIC ANTIGEN AS A SCREENING TEST : The Netherlands Experience
- Chris H. Bangma, John B.W. Rietbergen, Fritz H. Schröder
- PROSTATE-SPECIFIC ANTIGEN DENSITY
- Mario C. Beduschi, Joseph E. Oesterling
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