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Population-based Organised Prostate Cancer Testing : Results from the First Invitation of 50-year-old Men

Bratt, Ola LU ; Godtman, Rebecka Arnsrud ; Jiborn, Thomas LU ; Wallström, Jonas ; Akre, Olof ; Carlsson, Stefan ; Nordström, Tobias ; Thimansson, Erik ; Alterbeck, Max LU and Zackrisson, Sophia LU , et al. (2024) In European Urology 85(3). p.207-214
Abstract

Background: The European Union recently recommended evaluation of the feasibility of organised prostate cancer screening. In Sweden, regional population-based organised prostate cancer testing (OPT) programmes were introduced in 2020. Objective: To describe initial participation rates and diagnostic outcomes. Design, setting, and participants: The three most populated Swedish regions invited all men aged 50 yr to OPT by a letter in 2020–2022. Men with prostate-specific antigen (PSA) ≥3 ng/ml were referred for prostate magnetic resonance imaging (MRI). PSA assays differed across regions. Men with Prostate Imaging Reporting and Data System (PI-RADS) 1–3 and PSA density ≥0.15 ng/ml/cm3 or PI-RADS 4–5 were referred for a biopsy.... (More)

Background: The European Union recently recommended evaluation of the feasibility of organised prostate cancer screening. In Sweden, regional population-based organised prostate cancer testing (OPT) programmes were introduced in 2020. Objective: To describe initial participation rates and diagnostic outcomes. Design, setting, and participants: The three most populated Swedish regions invited all men aged 50 yr to OPT by a letter in 2020–2022. Men with prostate-specific antigen (PSA) ≥3 ng/ml were referred for prostate magnetic resonance imaging (MRI). PSA assays differed across regions. Men with Prostate Imaging Reporting and Data System (PI-RADS) 1–3 and PSA density ≥0.15 ng/ml/cm3 or PI-RADS 4–5 were referred for a biopsy. Data were obtained from the Swedish Register for Organised Prostate Cancer Testing. Outcome measurements and statistical analysis: Overall and regional participation rates, PSA distributions, PI-RADS score distributions, cancer detection, and treatment were evaluated. Results and limitations: A total of 23 855 (35%) of 68 060 invited men participated; 696 (2.9%) had PSA ≥3 ng/ml, and of them, 306 (44%) had a biopsy indication and 221 (32%) had a biopsy. On biopsy, 93 (42%) had Gleason grade group ≥2 (0.39% of PSA-tested men) and 44 (20%) Gleason grade group 1 cancer. Most men with cancer had treatment with curative intent (70%) or were under active surveillance (28%). Across regions, proportions of men with PSA ≥3 ng/ml ranged from 2.3% to 4.0%, and those with PI-RADS score 4–5 ranged from 12% to 21%. A limitation is that results are applicable only to first testing of men in their early 50s. Conclusions: The OPT programmes are feasible with good compliance to the diagnostic pathway. The use of MRI and PSA density avoided a biopsy for over half of the men with PSA ≥3 ng/ml. Inter-regional differences in diagnostic outcomes show a need for standardisation of the diagnostic pathway's components. Patient summary: We report the diagnostic outcomes of inviting 68 000 50-yr-old men to organised prostate cancer testing.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Early detection, Population, Prostate cancer, Prostate-specific antigen, Screening
in
European Urology
volume
85
issue
3
pages
8 pages
publisher
Elsevier
external identifiers
  • pmid:38042646
  • scopus:85178621530
ISSN
0302-2838
DOI
10.1016/j.eururo.2023.11.013
language
English
LU publication?
yes
id
7b3afc0e-6a83-468e-b6d8-8f54c643c6b8
date added to LUP
2025-01-13 14:42:30
date last changed
2025-01-27 16:11:55
@article{7b3afc0e-6a83-468e-b6d8-8f54c643c6b8,
  abstract     = {{<p>Background: The European Union recently recommended evaluation of the feasibility of organised prostate cancer screening. In Sweden, regional population-based organised prostate cancer testing (OPT) programmes were introduced in 2020. Objective: To describe initial participation rates and diagnostic outcomes. Design, setting, and participants: The three most populated Swedish regions invited all men aged 50 yr to OPT by a letter in 2020–2022. Men with prostate-specific antigen (PSA) ≥3 ng/ml were referred for prostate magnetic resonance imaging (MRI). PSA assays differed across regions. Men with Prostate Imaging Reporting and Data System (PI-RADS) 1–3 and PSA density ≥0.15 ng/ml/cm<sup>3</sup> or PI-RADS 4–5 were referred for a biopsy. Data were obtained from the Swedish Register for Organised Prostate Cancer Testing. Outcome measurements and statistical analysis: Overall and regional participation rates, PSA distributions, PI-RADS score distributions, cancer detection, and treatment were evaluated. Results and limitations: A total of 23 855 (35%) of 68 060 invited men participated; 696 (2.9%) had PSA ≥3 ng/ml, and of them, 306 (44%) had a biopsy indication and 221 (32%) had a biopsy. On biopsy, 93 (42%) had Gleason grade group ≥2 (0.39% of PSA-tested men) and 44 (20%) Gleason grade group 1 cancer. Most men with cancer had treatment with curative intent (70%) or were under active surveillance (28%). Across regions, proportions of men with PSA ≥3 ng/ml ranged from 2.3% to 4.0%, and those with PI-RADS score 4–5 ranged from 12% to 21%. A limitation is that results are applicable only to first testing of men in their early 50s. Conclusions: The OPT programmes are feasible with good compliance to the diagnostic pathway. The use of MRI and PSA density avoided a biopsy for over half of the men with PSA ≥3 ng/ml. Inter-regional differences in diagnostic outcomes show a need for standardisation of the diagnostic pathway's components. Patient summary: We report the diagnostic outcomes of inviting 68 000 50-yr-old men to organised prostate cancer testing.</p>}},
  author       = {{Bratt, Ola and Godtman, Rebecka Arnsrud and Jiborn, Thomas and Wallström, Jonas and Akre, Olof and Carlsson, Stefan and Nordström, Tobias and Thimansson, Erik and Alterbeck, Max and Zackrisson, Sophia and Hugosson, Jonas and Bjartell, Anders and Lantz, Anna}},
  issn         = {{0302-2838}},
  keywords     = {{Early detection; Population; Prostate cancer; Prostate-specific antigen; Screening}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{207--214}},
  publisher    = {{Elsevier}},
  series       = {{European Urology}},
  title        = {{Population-based Organised Prostate Cancer Testing : Results from the First Invitation of 50-year-old Men}},
  url          = {{http://dx.doi.org/10.1016/j.eururo.2023.11.013}},
  doi          = {{10.1016/j.eururo.2023.11.013}},
  volume       = {{85}},
  year         = {{2024}},
}