Simple PSA Retest Cuts False Alarms in Prostate Cancer Screening by Over One-Third
A major trial shows that retesting men's PSA levels just weeks after an initial high result eliminates unnecessary biopsies in 38% of cases, potentially reducing healthcare costs and patient anxiety. The finding could reshape prostate cancer screening protocols for insurers, health systems, and policymakers debating how to improve screening specificity.
Originaltitel: Confirmation of Prostate-specific Antigen (PSA) Values Improves Prostate Cancer Screening in Early Middle-Aged Men - Data from the PROBASE Trial.
Bekräftelseprov på PSA-värden kan minska onödiga utredningar i prostatacancerscreening för män 45–55 år och öka testets specificitet. PROBASE-studien analyserade 72 157 PSA-värden från screening. Av män med initialt PSA ≥3 ng/ml hade 38 procent ett PSA <3 ng/ml vid bekräftelsetest (median 28 dagar senare). Andelen varierade efter ålder: 46 procent bland 45-åringar respektive 34 procent bland 50-åringar. Sex år senare var prostatacancerrisken 33 procent för män med bekräftat förhöjt PSA jämfört med 7 procent för dem vars värde sjönk. Institutionen för personaliserad tidig prostatacancerdetektering vid tyska cancerforskningscentret DKFZ ledde arbetet tillsammans med Lund University. För regioner och inköpsorganisationer innebär resultaten lägre belastning på urologisk utredningskapacitet och färre onödiga biopsi- och bilddiagnostikinsatser när bekräftelseprov implementeras i screeningprotokoller.
BACKGROUND AND OBJECTIVE: To assess the effectiveness of a confirmatory prostate-specific antigen (PSA) test as a safeguard against unnecessary work-up and to improve the specificity of prostate cancer (PCa) screening. METHODS: Overall, 72,157 PSA values corresponding to screening rounds at age 45-55 yr in the PROBASE trial were analyzed. Positive PSA tests were reported as the proportion of men with an initial or confirmatory PSA ≥3 ng/ml. The cumulative PCa number over 6 yr was described for men with and without confirmatory PSA decrease at baseline screening (age 45 yr). Sankey diagrams were plotted to illustrate changes in PSA values over 10 yr with 2-yearly PSA screening. KEY FINDINGS AND LIMITATIONS: Overall, 2782 initial PSAs and 2702 (97%) confirmatory PSAs were observed. A total of 38% (95% confidence interval [CI] 36, 40) of men with initial PSA ≥3 ng/ml had a PSA <3 ng/ml at confirmatory testing. Estimates differed by age and screening round: 46% (95% CI 41, 51) in 45-yr-olds and 34% (95% CI 31, 38) in 50-yr-olds. PSA was repeated at a median of 28 d (interquartile range [IQR] 20, 39). Median change was -0.5 ng/ml (IQR -1.3, +0.06). PCa risk at 6 yr was 33% in those with confirmed PSA and 7.0% in those with PSA decrease at age 45 yr (risk ratio 4.68, CI 2.55, 8.59). The main limitation is incomplete biopsy information. CONCLUSION: PSA elevations in early-middle-aged men are common and PSA should be confirmed before initiating diagnostic work-up in a screening setting. CLINICAL IMPLICATIONS: Repeating PSA before initiating diagnostic work-up reduces immediate further diagnostics.