Prostate Exam Every 4 Years
The current guidelines of the American Cancer Society recommend
that men over age 50 should be "offered" a prostate
exam every year
The Story: A new European
study has shown that a thorough screening for prostate cancer every 4 years is
adequate. The screening comprises a PSA blood test, a digital rectal exam, and a transrectal
ultrasound. "Very few, if any, aggressive prostate cancers escape (this) screening...."
Comment: It looks as if the
American Cancer Society guidelines for prostate cancer screening may be
changing. Transurethral ultrasound is a procedure used to examine the prostate.
An instrument (the ultrasound probe) is inserted into the rectum, and sound waves bounce off the prostate. These sound
waves create echoes, which a computer uses to create a picture called a sonogram
of the prostate.
For more in-depth information, please see the following areas:
Articles
Centers
Barbara K. Hecht,
Ph.D.
Frederick Hecht, M.D.
Medical Editors, MedicineNet.com
Prostate Cancer Screening Interval of 4 Years Misses Few Cancers, Study
Shows
Linda Wang, Assistant
News Editor, Katherine Arnold, News Editor, Journal of the National Cancer
Institute
A 4-year screening interval was adequate to detect most cancers in
a large European randomized trial of prostate cancer screening, according
to a study in the October 1 issue of the Journal of the National
Cancer Institute.
The European Randomized Study of Screening for Prostate
Cancer (ERSPC) is an ongoing randomized trial to determine the effect of
screening on deaths from prostate cancer. Study participants randomly assigned
to the intervention arm are screened every 4 years with a prostate-specific
antigen (PSA) test, a digital rectal exam, and a transrectal ultrasound exam.
Little is known about the sensitivity, or the percentage of people who test
positive for a disease among
people who have the disease, of these screening tests and the
appropriateness of the 4-year screening interval.
To address these issues, Ingrid W. van der
Cruijsen-Koeter, M.D., T. H. van der Kwast, M.D., Ph.D., and Fritz H. Schroder,
M.D., Ph.D., of the Erasmus MC, University Medical Center in Rotterdam,
Netherlands, looked at the rate of interval cancers (i.e., cancers detected
between screening visits) among 17,226 men ages 55 to 74 who were enrolled in
the Rotterdam section of the ERSPC. The
occurrence of interval cancers can be used to determine whether
screening tests are sensitive enough, and whether the screening
interval is appropriate.
In the study, men were divided into two groups: an
intervention group that received two scheduled screens 4 years apart, and a
control group that did not receive scheduled screening. The researchers checked
the Dutch national cancer registry annually for cases of
prostate cancer among the study participants.
During the 4-year screening period, 18 "true" interval cancers
were diagnosed in men in the intervention group and 135 cancers were
diagnosed in men in the control group, suggesting a low rate of
interval cancers among men in the intervention group. The authors
determined that the screening procedure has a high sensitivity of
85.5%.
The authors conclude that the low rate of interval
cancers found within the ERSPC-Rotterdam confirms a high sensitivity of the
screening procedure. They add that the interval cancers were at a locally
confined stage, suggesting that "very few, if any, aggressive
prostate cancers escape screening with the procedures used within
the ERSPC."
Last Editorial Review: 10/1/2003
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