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Research

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

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39381.436829.BE (Published 29 November 2007) Cite this as: BMJ 2007;335:1139
  1. J Athene Lane, senior research fellow1,
  2. Joanne Howson, lead research nurse2,
  3. Jenny L Donovan, professor1,
  4. John R Goepel, consultant histopathologist3,
  5. Daniel J Dedman, public health information specialist4,
  6. Liz Down, research associate1,
  7. Emma L Turner, research associate1,
  8. David E Neal, professor of surgical oncology5,
  9. Freddie C Hamdy, professor, head of urology and oncology2
  1. 1Department of Social Medicine, University of Bristol
  2. 2Academic Urology Unit, Section of Oncology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, S10 2JF
  3. 3Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital
  4. 4North West Public Health Observatory, Liverpool John Moores University, Liverpool
  5. 5Oncology Centre, Addenbrooke's Hospital, Cambridge
  1. Correspondence to: F C Hamdy f.c.hamdy{at}sheffield.ac.uk
  • Accepted 26 September 2007

Abstract

Objective To investigate the feasibility of testing for prostate cancer and the prevalence and characteristics of the disease in unselected young men.

Design Prospective cohort nested within a randomised controlled trial, 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 prostate specific antigen level of 1.5 ng/ml or more and the possibility of randomisation to three treatments for those with localised prostate cancer.

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

Results 442 of 1299 men agreed to be tested for prostate specific antigen (34%) and 54 (12%) had a raised level. The positive predictive value for prostate specific antigen was 21.3%. Ten cases of prostate cancer were detected (2.3%) with eight having at least two positive results in biopsy cores and three showing perineural invasion. One tumour was of high volume (cT2c), Gleason score 7, with a positive result on digital rectal examination; nine tumours were cT1c, Gleason score 6, and eight had a negative result on digital rectal examination. Five of the nine eligible participants (55%) agreed to be randomised. No biochemical disease progression in the form of a rising prostate specific antigen level occurred in two years of follow-up.

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

Trial registration Current Controlled Trials ISRCTN20141297

Footnotes

  • We thank the research group of the prostate testing for cancer and treatment study for their contribution and Richard Martin for his comments.

  • Contributors: JAL, JLD, DEN, and FCH had full access to the data in the study. JAL is the trial coordinator. JLD, DEN, and FCH are the principal investigators. JH, JRG, and FCH carried out the substudy. DJD, LD, and ELT contributed to data collection and analysis. JAL wrote the first draft and together with FCH wrote the final manuscript. All authors contributed to the intellectual content of the draft manuscript and approved the final version. JAL is guarantor of the paper.

  • Funding: The prostate testing for cancer and treatment study is funded and sponsored by the Health Technology Assessment programme (projects 96/20/06 and 96/20/99). The views and opinions expressed are those of the authors and do not necessarily reflect those of the Department of Health.

  • Competing interests: None declared.

  • Ethical approval: This study was approved by Trent multicentre research ethics committee.

    Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 26 September 2007
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