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Serendipity in detecting disease in low prostate‐specific antigen ranges
Author(s) -
Vis A.N.,
Kranse R.,
Roobol M.,
Van Der Kwast Th.H.,
Schröder F.H.
Publication year - 2002
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-4096.2001.01868.x
Subject(s) - prostate cancer , medicine , prostatectomy , rectal examination , prostate , transrectal ultrasonography , prostate specific antigen , urology , cancer , population , biopsy , prostate cancer screening , gynecology , oncology , environmental health
Objective To assess the magnitude of prostate cancer detection by serendipity (the coincidental detection of prostate cancer during the evaluation of an abnormal screening test result) when a digital rectal examination (DRE) and transrectal ultrasonography (TRUS) are used as initial screening tests for prostate cancer in men with low levels of prostate‐specific antigen (PSA; 0.0–3.9 ng/mL). Patients and methods In all, 117 participants of a population‐based screening study were diagnosed with prostate cancer after a standard evaluation of an abnormal screening test result; 49 underwent radical prostatectomy. Serendipity was defined as either: (i) the presence of prostate cancer opposite to the side that raised suspicion for cancer on DRE and/or TRUS; (ii) a negative lesion‐directed biopsy while cancer was present in one or more of the cores of the sextant biopsy; (iii) a tumour volume of < 0.5 mL on radical prostatectomy. Results Depending on the definition, 27–63% of prostate cancers detected at low PSA values were detected coincidentally and not as a result of a true‐positive test result. The proportion of cancers detected by serendipity was inversely correlated with serum PSA level. Conclusion A relatively high proportion of prostate cancers diagnosed in men with low PSA levels, and in which a biopsy was prompted by a suspicious DRE and/or TRUS, are considered to be detected by chance only. As these cancers are mostly small (< 0.5 mL), with potentially low biological aggressiveness, relying on serendipity seems disadvantageous in prostate‐cancer screening. The level of serendipity in prostate cancer detection, the poor performance of the screening test, and high inter‐observer variability, casts further doubt on the utility of DRE (and TRUS) as initial screening tests for prostate cancer in population‐based screening.