Detection of prostate cancer in unselected young men: prospective cohort nested within a randomised controlled trial

doi:10.1136/bmj.39381.436829.BE

BMJ 2007;335:1139 (1 December), doi:10.1136/bmj.39381.436829.BE (published 15 November 2007)

Research

Detection of prostate cancer in unselected young men: prospective cohort nested within a randomised controlled trial

J Athene Lane, senior research fellow¹, Joanne Howson, lead research nurse², Jenny L Donovan, professor¹, John R Goepel, consultant histopathologist³, Daniel J Dedman, public health information specialist⁴, Liz Down, research associate¹, Emma L Turner, research associate¹, David E Neal, professor of surgical oncology⁵, Freddie C Hamdy, professor, head of urology and oncology²

¹ Department of Social Medicine, University of Bristol, ² Academic Urology Unit, Section of Oncology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, S10 2JF , ³ Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, ⁴ North West Public Health Observatory, Liverpool John Moores University, Liverpool, ⁵ Oncology Centre, Addenbrooke's Hospital, Cambridge

Correspondence to: F C Hamdy f.c.hamdy{at}sheffield.ac.uk

Objective To investigate the feasibility of testing for prostatecancer and the prevalence and characteristics of the diseasein unselected young men.

Design Prospective cohort nested within a randomised controlledtrial, with two years of follow-up.

Setting Eight general practices in a UK city.

Participants 1299 unselected men aged 45-49.

Intervention Prostate biopsies for participants with a prostatespecific antigen level of 1.5 ng/ml or more and the possibilityof randomisation to three treatments for those with localisedprostate cancer.

Main outcome measures Uptake of testing for prostate specificantigen; positive predictive value of prostate specific antigen;and prevalence of prostate cancer, TNM disease stage, and histologicalgrade (Gleason score).

Results 442 of 1299 men agreed to be tested for prostate specificantigen (34%) and 54 (12%) had a raised level. The positivepredictive value for prostate specific antigen was 21.3%. Tencases of prostate cancer were detected (2.3%) with eight havingat least two positive results in biopsy cores and three showingperineural invasion. One tumour was of high volume (cT2c), Gleasonscore 7, with a positive result on digital rectal examination;nine tumours were cT1c, Gleason score 6, and eight had a negativeresult on digital rectal examination. Five of the nine eligibleparticipants (55%) agreed to be randomised. No biochemical diseaseprogression in the form of a rising prostate specific antigenlevel occurred in two years of follow-up.

Conclusions Men younger than 50 will accept testing for prostatecancer but at a much lower rate than older men. Using an agebased threshold of 1.5 ng/ml, the prevalence of prostate cancerwas similar to that in older men (3.0 ng/ml threshold) and somecancers of potential clinical significance were found.

Trial registration Current Controlled Trials ISRCTN20141297

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