EURURO-5647; No. of Pages 2 EUROPEAN UROLOGY XXX (2014) XXX–XXX
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Platinum Priority – Editorial Referring to the article published on pp. x–y of this issue
Toward a Smarter Prostate Cancer Screening Program Daniel D. Sjoberg * Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Prostate-specific antigen (PSA) screening has long been controversial. Many have questioned the efficacy of screening for improving prostate cancer survival and whether the benefits of screening outweigh the harms [1]. We now know that PSA screening is effective in reducing prostate cancer mortality [2]. With strong evidence in favor of PSA screening for improved mortality, there is a need to focus on reducing the harms of PSA screening, such as subjecting men to unnecessary biopsy and the diagnosis and treatment of indolent cancers. Typically, PSA screening has been a ‘‘one size fits all’’ program with which men have been screened uniformly, regardless of risk. For example, the American Urological Association recommends that men be screened every 2 yr. In this month’s issue of European Urology, Randazzo et al. show that by individualizing screening based on a patient’s baseline PSA measurement and extending screening intervals for men with low PSA, the rate of screening can be greatly reduced while maintaining a low risk of delaying an aggressive cancer diagnosis [3]. Similar results have been shown by Roobol et al. [4] and Carlsson et al. [5]. Moreover, it has also been shown that a baseline PSA measurement discriminates between men who will and will not develop lethal prostate cancer up to 25 yr later [6,7]. With growing evidence that the time between PSA screenings can be extended safely for men with low PSA, some argue that new PSA screening guidelines need to be preceded by prospective trials. Prospective trials are costly and time consuming. Furthermore, the results from a prospective trial would not be available for 20 yr, and in the interim, men will continue to be screened according the
current suboptimal guidelines. Given these limitations, a large-scale prospective trial likely will not move forward. At Memorial Sloan-Kettering Cancer Center, the screening guidelines have been updated to reflect the current literature supporting PSA-based screening intervals. Further adoption of these principles throughout the urologic community will clearly lead to improvement in the manner in which men are screened. With the availability of highquality PSA screening trial data coupled with data on the natural course of prostate cancer in unscreened populations, there is no reason to delay the acceptance of smarter PSA screening. Conflicts of interest: Daniel D. Sjoberg receives personal fees from OPKO Diagnostics, outside the submitted work.
References [1] Moyer VA, U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012;157:120–34. [2] Schro¨der FH1, Hugosson J, Roobol MJ, et al. ERSPC Investigators. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012;366:981–90. [3] Randazzo M, Beatrice J, Huber A, et al. A ‘‘PSA pyramid’’ for men with initial prostate-specific antigen 3 ng/ml: a plea for individualized prostate cancer screening. Eur Urol. In press. http://dx.doi.org/ 10.1016/j.eururo.2014.04.005 [4] Roobol MJ, Roobol DW, Schro¨der FH. Is additional testing necessary in men with prostate-specific antigen levels of 1.0 ng/mL or less in a population-based screening setting? (ERSPC, section Rotterdam) Urology 2005;65:343–6.
DOI of original article: http://dx.doi.org/10.1016/j.eururo.2014.04.005. * Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.eururo.2014.05.002 0302-2838/# 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Please cite this article in press as: Sjoberg DD. Toward a Smarter Prostate Cancer Screening Program. Eur Urol (2014), http:// dx.doi.org/10.1016/j.eururo.2014.05.002
EURURO-5647; No. of Pages 2 2
EUROPEAN UROLOGY XXX (2014) XXX–XXX
[5] Carlsson S, Assel M, Sjoberg D, et al. Influence of blood prostate specific antigen levels at age 60 on benefits and harms of prostate cancer screening: population based cohort study. BMJ 2014;348:g2296. [6] Vickers AJ, Ulmert D, Sjoberg DD, et al. Strategy for detection of prostate cancer based on relation between prostate specific antigen
at age 40–55 and long term risk of metastasis: case-control study. BMJ 2013;346:f2023. [7] Vickers AJ, Cronin AM, Bjo¨rk T, et al. Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: case-control study. BMJ 2010;341:c4521.
Please cite this article in press as: Sjoberg DD. Toward a Smarter Prostate Cancer Screening Program. Eur Urol (2014), http:// dx.doi.org/10.1016/j.eururo.2014.05.002
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Platinum Priority – Editorial Referring to the article published on pp. x–y of this issue
Toward a Smarter Prostate Cancer Screening Program Daniel D. Sjoberg * Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Prostate-specific antigen (PSA) screening has long been controversial. Many have questioned the efficacy of screening for improving prostate cancer survival and whether the benefits of screening outweigh the harms [1]. We now know that PSA screening is effective in reducing prostate cancer mortality [2]. With strong evidence in favor of PSA screening for improved mortality, there is a need to focus on reducing the harms of PSA screening, such as subjecting men to unnecessary biopsy and the diagnosis and treatment of indolent cancers. Typically, PSA screening has been a ‘‘one size fits all’’ program with which men have been screened uniformly, regardless of risk. For example, the American Urological Association recommends that men be screened every 2 yr. In this month’s issue of European Urology, Randazzo et al. show that by individualizing screening based on a patient’s baseline PSA measurement and extending screening intervals for men with low PSA, the rate of screening can be greatly reduced while maintaining a low risk of delaying an aggressive cancer diagnosis [3]. Similar results have been shown by Roobol et al. [4] and Carlsson et al. [5]. Moreover, it has also been shown that a baseline PSA measurement discriminates between men who will and will not develop lethal prostate cancer up to 25 yr later [6,7]. With growing evidence that the time between PSA screenings can be extended safely for men with low PSA, some argue that new PSA screening guidelines need to be preceded by prospective trials. Prospective trials are costly and time consuming. Furthermore, the results from a prospective trial would not be available for 20 yr, and in the interim, men will continue to be screened according the
current suboptimal guidelines. Given these limitations, a large-scale prospective trial likely will not move forward. At Memorial Sloan-Kettering Cancer Center, the screening guidelines have been updated to reflect the current literature supporting PSA-based screening intervals. Further adoption of these principles throughout the urologic community will clearly lead to improvement in the manner in which men are screened. With the availability of highquality PSA screening trial data coupled with data on the natural course of prostate cancer in unscreened populations, there is no reason to delay the acceptance of smarter PSA screening. Conflicts of interest: Daniel D. Sjoberg receives personal fees from OPKO Diagnostics, outside the submitted work.
References [1] Moyer VA, U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012;157:120–34. [2] Schro¨der FH1, Hugosson J, Roobol MJ, et al. ERSPC Investigators. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012;366:981–90. [3] Randazzo M, Beatrice J, Huber A, et al. A ‘‘PSA pyramid’’ for men with initial prostate-specific antigen 3 ng/ml: a plea for individualized prostate cancer screening. Eur Urol. In press. http://dx.doi.org/ 10.1016/j.eururo.2014.04.005 [4] Roobol MJ, Roobol DW, Schro¨der FH. Is additional testing necessary in men with prostate-specific antigen levels of 1.0 ng/mL or less in a population-based screening setting? (ERSPC, section Rotterdam) Urology 2005;65:343–6.
DOI of original article: http://dx.doi.org/10.1016/j.eururo.2014.04.005. * Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.eururo.2014.05.002 0302-2838/# 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Please cite this article in press as: Sjoberg DD. Toward a Smarter Prostate Cancer Screening Program. Eur Urol (2014), http:// dx.doi.org/10.1016/j.eururo.2014.05.002
EURURO-5647; No. of Pages 2 2
EUROPEAN UROLOGY XXX (2014) XXX–XXX
[5] Carlsson S, Assel M, Sjoberg D, et al. Influence of blood prostate specific antigen levels at age 60 on benefits and harms of prostate cancer screening: population based cohort study. BMJ 2014;348:g2296. [6] Vickers AJ, Ulmert D, Sjoberg DD, et al. Strategy for detection of prostate cancer based on relation between prostate specific antigen
at age 40–55 and long term risk of metastasis: case-control study. BMJ 2013;346:f2023. [7] Vickers AJ, Cronin AM, Bjo¨rk T, et al. Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: case-control study. BMJ 2010;341:c4521.
Please cite this article in press as: Sjoberg DD. Toward a Smarter Prostate Cancer Screening Program. Eur Urol (2014), http:// dx.doi.org/10.1016/j.eururo.2014.05.002
