Introduction
Opportunistic PSA screening is no longer recommended in many Western countries due to overdiagnosis of low risk prostate cancer (PCa). According to national and international mortality statistics Estonia remains a country of very high PCa mortality rates. The role of opportunistic PSA screening for prostate remains unclear in high PCa mortality countries.
Aim
The aim of our study was to compare the presence of PCa in opportunistically screened and symptomatic patient groups and evaluate the positive value of screening.
Methods
During the years 2013-2015 a prospective data on all patients (n=1069) who were referred to urologist at our academic medical centre and underwent prostate biopsy was collected. All primary biopsies patients were divided into two groups: an opportunistically found elevated PSA group (n=416) and symptomatic patient group as a control (n=349). All data regarding age, PSA value, prostate size and PCa stage were analysed.
Results
We found that age and prostate size of the patients were significantly higher in control group (p < 0.005*) and incidence of primary prostate cancer was significantly higher in opportunistic group (p < 0.05*, RR 1.15). There was no difference in proportion of locally advanced and metastatic disease between groups. All localised PCa cases were stratified to the risk groups according to EAU Guidelines. During comparison of PCa risk groups we found that there no difference in the incidence of high risk PCa. But there was statistically significant higher incidence of low (p < 0.05*, RR 1.16) and intermediate risk (p < 0.05*, RR 1.20) PCa in opportunistic group than in control.
Conclusion
Despite the higher incidence of low risk PCa in opportunistic PSA screening group compared with control we still found higher incidence of intermediate risk and relatively high rate of high risk cancers in younger age group of patients who may potentially suffer from advanced disease in the future if left untreated. The similar incidence of locally advanced and metastatic disease in both groups may support the use of opportunistic PSA screening in high PCa mortality countries where active screening is not possible due to certain reasons.
