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

Ola Bratt; Rebecka Arnsrud Godtman; Thomas Jiborn; Jonas Wallström; Olof Akre; Stefan Carlsson; Tobias Nordström; Erik Thimansson; Max Alterbeck; Sophia Zackrisson; Jonas Hugosson; Anders Bjartell; Anna Lantz

doi:10.1016/j.eururo.2023.11.013

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

Eur Urol. 2024 Mar;85(3):207-214. doi: 10.1016/j.eururo.2023.11.013. Epub 2023 Dec 1.

Authors

Affiliations

¹ Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: ola.bratt@gu.se.
² Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
³ Department of Urology, Skåne University Hospital, Malmö, Sweden.
⁴ Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁵ Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
⁶ Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
⁷ Department of Translational Medicine, Faculty of Medicine, Lund University, Lund, Sweden; Department of Radiology, Helsingborg Hospital, Helsingborg, Sweden.
⁸ Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
⁹ Department of Translational Medicine, Faculty of Medicine, Lund University, Lund, Sweden; Department of Imaging and Physiology, Skåne University Hospital, Malmö, Sweden.
¹⁰ Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.

PMID: 38042646
DOI: 10.1016/j.eururo.2023.11.013

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. 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.

Keywords: Early detection; Population; Prostate cancer; Prostate-specific antigen; Screening.

MeSH terms

Early Detection of Cancer
Humans
Image-Guided Biopsy / methods
Magnetic Resonance Imaging / methods
Male
Middle Aged
Prostate / pathology
Prostate-Specific Antigen
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / pathology

Substances

Prostate-Specific Antigen