Incidence of insignificant prostate cancer using free/total PSA: results of a case-finding protocol on 14,453 patients

Pietro Pepe (1) , Francesco Aragona (1)

1 Urology

ABSTRACT To evaluate prostate cancer (PCa) detection and incidence of pathologically insignificant tumour (pIPCa) using percent free PSA (%f-PSA) in patients with total PSA < 10 ng/mL. From February 2002 to October 2009, 14453 patients (median 60.5 years), were enrolled in a case-finding protocol for the early diagnosis of PCa. Indications to biopsy were: suspicious digital rectal examination; PSA > 10 ng/mL; PSA ≤ 2.5 ng/mL, included between 2.6- 4 or 4.1-10 ng/mL with %f-PSA < 15%, < 20% and < 25%, respectively. A median of 18 and 26 cores in case of primary and repeated biopsy were performed; 2,123 men underwent prostate biopsy and 1589 (74.8%) of them had a PSA < 10 ng/mL. A PCa was found in 777 (36.6%) and in 35 (23.3%) patients at primary and repeated biopsy: 459 and 26 men had PSA < 10 ng/mL and 419 and 26 patients underwent surgery, respectively: 244 (58.3%) and 18 (69.2%) had an organ-confined PCa with a pIPCa incidence equal to 1.4% and 7.7%, respectively. Cancer detection rate of 28.8% in patients with PSA < 10 ng/mL associated with a low incidence of pIPCa should induce to introduce %f-PSA in screening programs to reduce the risk of overdiagnosis. Key words: prostate cancer; PCa screening; PCa early diagnosis; PSA free/total; Overdiagnosis and PCa; Overtreatment and PCa

Mots clés: prostate cancer; PCa screening; PCa early diagnosis; PSA free/total; Overdiagnosis and PCa; Overtreatment and PCa

Pietro Pepe, Francesco Aragona. Incidence of insignificant prostate cancer using free/total PSA: results of a case-finding protocol on 14,453 patients. Prostate Cancer and Prostatic Diseases, 2010, ⟨10.1038/pcan.2010.29⟩. ⟨hal-00566755⟩