Detection rates of cancer, high grade PIN and atypical lesions suspicious for cancer in the European Randomized Study of Screening for Prostate Cancer
Introduction
High grade prostatic intraepithelial neoplasia (PIN) is a neoplastic transformation of superficial secretory epithelial cells of prostatic ducts and glands, characterised by cell atypia, prominent nucleoli, secretory cell proliferation and interruption of basal cell layer in architecturally benign glands.1, 2 High grade PIN is generally considered as a precancerous state for prostate cancer, while detectable in at least 70% of prostatectomies containing a prostate cancer.2, 3, 4 The prevalence of isolated high grade PIN in prostate biopsies is reported to show wide variation in the earlier studies. The mean reported incidence of isolated high grade PIN was 9%,3, 4 showing variation from 4.4% to 25% in biopsies from urological practice.4 Lower prevalence of PIN in prostate biopsies has been reported along with increased use of PSA-testing,5 as well as during the PSA screening in one screening centre.6 The clinical significance of isolated high grade PIN is based on the demonstration in older studies of a high risk of subsequent prostate cancer in follow-up biopsies.5, 7 These data have been mainly obtained from studies of non-screened populations. Based on these studies early re-biopsy was recommended for patients with high grade PIN,4 and this recommendation has been followed also in the screening centres. As a consequence a substantial proportion of asymptomatic men screened for prostate cancer needed to undergo an additional biopsy, which is undesirable in a screening setting. However, the reported predictive value of PIN for subsequent carcinoma has decreased during the last years.6, 8 Particularly, studies comparing the incidence of prostate cancer after an initial diagnosis of isolated high grade PIN with that after a benign biopsy diagnosis did not reveal significant differences.5, 7
Lesions suspicious for but not diagnostic of prostate cancer and LSPC have also been called glandular atypia or more commonly ASAP (atypical small acinar proliferation).8 Difficulties to render a definitive diagnosis of cancer in case of small atypical lesions have been shown recently.9 Suspicious lesions have been followed by much higher cancer detection rates than PIN,5, 6, 8 and therefore a re-biopsy has often been recommended by pathologists after LSPC diagnosis.
In the present study the detection rates for prostate cancer, PIN and LSPC in five centres of ERSPC study were determined. A further aim of the study is to identify changes in their incidences during subsequent screening rounds and the risk of cancer detection in subsequent prostate biopsies.
Section snippets
Participating ERSPC centres
In the European Randomized Study of Screening for Prostate Cancer, 182,000 men aged 51–75 years were randomised in a screening arm and a control arm in eight countries. Study group of the present study consists of 56,653 screened men in five ERSPC centres, Finland, Italy, Netherlands, Sweden and Switzerland, who underwent 3–7 screening rounds. Age range at entry was 51–66 years in Sweden, 55–67 years in Finland, 55–75 years in the Netherlands and Italy and 55–69 years in Switzerland.
Results
Average cancer detection rate in the screening arm of the five centres combined during the three first rounds was 3.5%, 3.2% and 3.5% in the first, second and third rounds, respectively (Table 1). Data were based on 17,864 biopsies, from which 4178 cancers were detected – that is an average positive biopsy percentage for all three rounds in the five centres of 23.4% and cancer detection rate of 3.4% (data not shown). When we compare the cancer detection rates per screening round in each of the
Discussion
The rate of cancer detection in the present study was fairly stable during the three rounds, although there was considerable variation between the centres. The rate was lowest in Italy. Reasons for the difference between centres may be due to many factors, for example the comparatively low biopsy compliance in Italy as reported previously.11 The average detection rate of prostate cancer (3.4%) in the five screening centres is higher than the general detection rate in these countries (from 0.8%
Conflict of interest statement
None declared.
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