Table Of ContentPROSTATE CANCER SCREENING
CURRENT CLINICAL UROLOGY
Eric A. Klein,
SERIES EDITOR
Prostate Cancer Screening, edited by Ian M. Thompson, Martin I.
Resnick, and Eric A. Klein, 2001
Bladder Cancer: Current Diagnosis and Treatment, edited by Michael J.
Droller, 2001
Office Urology: The Clinician's Guide, edited by Elroy D. Kursh and
James C. Ulchaker, 2001
Voiding Dysfunction: Diagnosis and Treatment, edited by Rodney A.
Appell, 2000
Management of Prostate Cancer, edited by Eric A. Klein, 2000
PROSTATE
CANCER
SCREENING
Edited by
M.
IAN THOMPSON, MD
The University ofT exas Health Science Center at San Antonio
San Antonio, TX
I.
MARTIN RESNICK, MD
Case western Reserve University
University Hospitals ofC leveland
Cleveland, OH
ERIC A. KLEIN, MD
Cleveland Clinic Foundation
Cleveland, OH
~
~
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
© 2001 Springer Seienee+Business Media New York
OriginalIy published by Humana Press Ine. in 2001
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Library of Congress Cataloging-in-Publication Data
Prostate cancer screening / edited by lan M. Thompson, Martin 1. Resnick, Eric A. Klein.
p. ;cm.-(Current Clinic al Urology)
Includes bibliographical referenees and index.
ISBN 978-1-4757-6306-5 ISBN 978-1-59259-099-5 (eBook)
DOI 10.1007/978-1-59259-099-5
1. Prostate-Cancer-Diagnosis. 2. Medical sereening. 1. Thompson, lan M. (lan Murchie), 1954-
II. Resnick, Martin 1. III. Klein Erie A., 1955-IV. Series.
[DNLM: 1. Prostatie Neoplasms-diagnosis. 2. Mass Screening. 3. Prostate-Specific Antigen. WJ
752 P96554 2000]
RC280.P7 P75985 2000
616.99'463075-de21 00-044884
PREFACE
Perhaps no other subject in medicine has prompted such discussion, often
with some animosity and certainly always with animation, as has the subject of
screening for prostate cancer. Prior to the development of prostate specific antigen,
screening was only a curiosity-an anecdote periodically due to the haphazard
application of digital rectal examination. With PSA, however, screening was not
only possible, but many men were found with the disease. The rate of increase in
prostate cancer diagnoses in the late 1980s and early 1990s was unsurpassed by any
other tumor in the history of modem public health statistics.
We may never know all the "right" answers regarding prostate cancer
screening. We are currently awaiting the completion of very large clinical trials
in Europe and the United States, designed to answer the question. However, for
the man at risk for the disease and for his physician, be it urologist, internist, or
family physician, the issue is: What to do now?
Prostate Cancer Screening is designed to help answer many of these ques
tions. A balanced set of discussions is included that will provide an excellent,
in-depth understanding for the physician and for the patient who strive to
understand as much as possible about the disease and screening. This book is
also designed for health care organizations that are struggling with the applica
tion of varying recommendations from medical specialty organizations.
There is no right answer, only choices. The premise of Prostate Cancer
Screening is that, armed with information and augmented by personal priorities
and expectations, both patients and physicians can make informed choices. If
that is achieved, we have attained our goal.
Ian Thompson,
MD
Martin I. Resnick, MD
Eric A. Klein,
MD
v
CONTENTS
Preface .......................................................................................... v
List of Contributors ....................................................................... ix
1 Epidemiology of Prostate Cancer
Wael A. Sakr and Clara Ward ............................................ 1
2 Natural History of Prostate Cancer
Peter C. Albertsen ............................................................. 25
3 Mathematical Issues: PSA Testing
Ruth Etzioni and David F. Penson .................................. 47
4 Evidence of Benefit of Screening in Other Cancers
Ismail Jatoi ......................................................................... 63
5 The Role of Prostate Specific Antigen and Its Variants in
Prostate Cancer Screening
Faiyaaz M. Jhaveri, Michael K. Brawer,
and Eric A. Klein ........................................................... 79
6 The Digital Rectal Examination in Prostate Cancer
Screening
Joseph Basler .................................................................... 91
7 Philosophical Reflections on PSA Screening:
What Should We Now Think and Do?
Paul H. Lange ..................................................................... 97
8 Imaging in Prostate Cancer Screening
Aaron Sulman and Martin I. Resnick ............................ 105
9 Risk Factors for Prostate Cancer
David L. Shepherd. .......................................................... 131
10 Transrectal Ultrasound and Artificial Neural Networks
in the Diagnosis of Prostate Cancer
Til/mann Loch .................................................................. 147
11 Evidence of the Effectiveness of Prostate
Cancer Screening
Chris Magee and Ian M. Thompson .............................. 157
vii
viii Contents
12 Prostate Cancer Screening: A Note of Caution
Otis W. Brawley ............................................................... 175
13 Quality of Life and Health Behavior in Prostate Cancer
Screening Populations
Mark S. Litwin and Kristen A. Reid ............................... 187
14 Prostate Cancer Screening Recommendations from
Organized Medicine
Gregory T. Sweat ............................................................. 209
15 Informed Consent and Prostate Specific Antigen
Screening: What Patients Ought to Know
Evelyn C. Y. Chan ............................................................ 223
16 Experience of Prostate Cancer Awareness Week
Zinelabidine Abouelfadel and E. David Crawford ...... 239
17 The Laval University Screening Trial Results
Fernand Labrie, Bernard Candas, Lionel Cusan,
and Jose-Luis Gomez ................................................ 255
18 Cancer of the Prostate Risk Index Test and Software
(CAPRI) [CAPRI SOFTWARE ON ATTACHED CD ROM]
Scott A. Optenberg, Atanacio C. Guillen,
John P. Campbell, and Ian M. Thompson ............... 281
19 The European Randomized Study of Screening for
Prostate Cancer (ERSPC)
Fritz H. Schroder and
Ingrid van der Cruijsen-Koeter for the ERSPC
Study Group ................................................................ 291
Index ......................................................................................... 311
CONTRIBUTORS
ZINELABIDINE ABOUELFADEL, MD • Division of Urology, University of Colorado
Health Sciences Center, Denver, CO
PETER C. ALBERTSEN, MD • Division of Urology, University of Connecticut
Health Center, Farmington, CT
JOSEPH BASLER, PhD, MD • Division of Urology, University of Texas Health
Science Center, San Antonio, TX
MICHAEL K. BRAWER, MD· Northwest Prostate Institute, Seattle, WA
OTIS W. BRAWLEY, MD· Assistant Director, National Cancer Institute, National
Institutes of Health, Bethesda, MD
JOHN P. CAMPBELL, MS • Systems Analyst, Litton/PRC, San Antonio, TX
BERNARD CANDAS, PhD • Prostate Cancer Clinical Research Unit, Department
of Medicine ad Oncology and Molecular Endocrinology Research Center,
Laval University Hospital (CHUL), Quebec, Canada
EVELYN C. Y. CHAN, MD, MS • Assistant Professor and Director, Clinical Bioethics,
Division of General Internal Medicine, Department ofM edicine, The University
of Texas-Houston Health Science Center, Houston, TX
E. DAVID CRAWFORD, MD • Division of Urology, University of Colorado
Health Sciences Center, Denver, CO
LIONEL CUSAN, MD, PhD· Prostate Cancer Clinical Research Unit, Department
of Medicine ad Oncology and Molecular Endocrinology Research Center,
Laval University Hospital (CHUL), Quebec, Canada
RUTH ETZIONI • Fred Hutchinson Cancer Research Center and University
of Washington, Seattle, WA
JosE-LUIS GOMEZ, MD, PhD • Prostate Cancer Clinical Research Unit, Department
ofM edicine ad Oncology and Molecular Endocrinology Research Center,
Laval University Hospital (CHUL), Quebec, Canada
ATANACIO C. GUILLEN, MS • Systems Analyst, Litton/PRC, San Antonio, TX
ISMAIL JATO!, MD, PhD, FACS • Uniformed Services University of the Health
Sciences, Bethesda, MD and Brooke Army Medical Center, Fort Sam
Houston, TX
FAIYAAZ M. JHAVERI, MD • Northwest Prostate Institute, Seattle, WA
ERIC A. KLEIN, MD • Department of Urology, Cleveland Clinic Foundation,
Cleveland, OH
ix
x Contributors
FERNAND LABRIE, MD, PhD • Prostate Cancer Clinical Research Unit, Department
of Medicine ad Oncology and Molecular Endocrinology Research Center,
Laval University Hospital (CHUL), Quebec, Canada
PAUL H. LANGE, MD· Department of Urology, University of Washington
School of Medicine, Seattle, WA
MARK S. LITWIN, MD, MPH • Departments of Urology and Health Services, University
of California, Los Angeles, CA
TILLMAN LOCH, MD, PhD· Klinik und Poliklinikfiir Urologie und
Kinderurologie der Universitdt des Saarlandes, Homburg, Germany
CHRIS MAGEE, MD • Division of Urology, the University of Texas Health Sciences
Center at San Antonio, San Antonio, TX
SCOTT A. OPTENBERG, PhD • Professor, Department of Surgery, University
of Texas Health Science Center at San Antonio, San Antonio, TX
DAVID F. PENSON • Fred Hutchinson Cancer Research Center and University
of Washington, Seattle, WA
KRISTEN A. REID, BA • Departments of Urology and Health Services, University
of California, Los Angeles, CA
MARTIN I. RESNICK, MD • Chairman, Department of Urology, School ofM edicine,
Case Western Reserve University, Cleveland, OH
WAEL A. SAKR, MD • Department of Pathology, Wayne State University,
and the Karmanos Cancer Institute, Detroit, MI
FRITZ H. SCHRODER, MD, PhD • Professor and Chairman, Department of Urology,
Erasmus University and Academic Hospital Rotterdam, The Netherlands
DAVID L. SHEPHERD, MD • Division of Urology, Department of Surgery, University
of Texas Health Science Center at San Antonio, San Antonio, TX
AARON SULMAN, MD • Department of Urology, School ofM edicine, Case Western
Reserve University, Cleveland, OH
GREGORY T. SWEAT, MD· Senior Associate Consultant, Department of Family
Medicine, Mayo Medical School, Mayo Clinic, Rochester, MN
IAN M. THOMPSON, MD • Professor and Chief, Division of Urology, The University
of Texas Health Science Center at San Antonio, San Antonio, TX
INGRID VAN DER CRUIJSEN-KOETER, MD • Department of Urology, Academic
Hospital and Erasmus University Rotterdam, The Netherlands
CLARA WARD, MD • Department of Pathology, Wayne State University,
and the Karmanos Cancer Institute, Detroit, MI
1
Epidemiology of Prostate Cancer
Wael A. Sakr, MD and Clara Ward, MA
CONTENTS
INTRODUCTION
RISK FACTORS
EPIDEMIOLOGY OF THE EARL Y PROSTATIC NEOPLASIA
CHANGES IN PROST AT E CANCER EPIDEMIOLOGY DURING
THE PSA ERA
REFERENCES
INTRODUCTION
The approach we followed to review the epidemiology of prostate
cancer was to divide this chapter into three major sections. The first
section provides a brief summary of the prevalence, incidence, and
mortality data worldwide and in the United States. These data are com
pared for different geographic areas and among different ethnic groups,
with an attempt to address how suspected risk factors for prostate cancer
may relate to the observed global discrepancies with respect to inci
dence and mortality rates. The data provided in the first section pertain
primarily, although not exclusively, to clinically evident prostate can
cer. As it is becoming increasingly recognized that prostatic neoplasia
covers a wide biological spectrum, the second section reviews available
epidemiological data on the early "phases" ofthe diseases, specifically
precursor lesions and preinvasive neoplasia, and the category of pre
clinical or the so-called "latent" prostate cancer. Finally, the third sec
tion highlights some of the changes in the clinicopathological profile of
prostate cancer diagnosed in the prostate-specific antigen (PSA) era of
the 1990s: During the last decade, the Western Hemisphere in particular
has witnessed significant changes in the profile of both the patients
diagnosed with prostate cancer and the characteristics of their tumors.
From: Current Clinical Urology: Prostate CancerScreening
Edited by: I. M. Thompson, M. I. Resnick, and E. A. Klein
© Humana Press Inc., Totowa, NJ
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