Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only.

Background: Screening for prostate cancer is burdened by a high rate of overdiagnosis. The most appropriate algorithm for population-based screening is unknown.

Methods: We invited 37,887 men who were 50 to 60 years of age to undergo regular prostate-specific antigen (PSA) screening.

Results from 22 years of Followup in the Göteborg Randomized Population-Based Prostate Cancer Screening Trial.

Purpose: Our goal was to analyze results from 22 years of followup in the Göteborg randomized prostate cancer (PC) screening trial.

Materials And Methods: In December 1994, 20,000 men born 1930-1944 were randomly extracted from the Swedish population register and were randomized (1:1) into either a screening group (SG) or to a control group (CG). Men in the SG were repeatedly invited for biennial prostate specific antigen testing up to an average age of 69 years.

The Association Between Age, Prostate Cancer Risk, and Higher Gleason Score in a Long-term Screening Program: Results from the Göteborg-1 Prostate Cancer Screening Trial.

Background: Studies have suggested associations between greater age, increased risk of prostate cancer (PC), and higher Gleason score.

Objective: The present study aimed at investigating these associations within the Göteborg-1 randomized, population-based PC screening trial.

Design, Setting, And Participants: The screening arm of the Göteborg-1 screening trial comprises 10000 randomly selected men (aged 50-64 yr at randomization) from the Göteborg region of Sweden.

Prostate Cancer Screening with Magnetic Resonance Imaging: Results from the Second Round of the Göteborg Prostate Cancer Screening 2 Trial.

Background: The Göteborg 2 prostate cancer (PC) screening (G2) trial evaluates screening with prostate-specific antigen (PSA) followed by magnetic resonance imaging (MRI) in case of elevated PSA levels.

Objective: To assess the safety of using a 2-yr interval in men who were previously screened positive with PSA but had negative MRI or positive MRI with a negative biopsy.

Design, Setting, And Participants: A total of 61 201 men aged 50-60 yr were randomized and 38 366 were invited for screening (years 2015-2020).

Long-term Outcomes for Men in a Prostate Screening Trial with an Initial Benign Prostate Biopsy: A Population-based Cohort.

Background: The optimal follow-up regimen for men after a benign prostate biopsy remains unknown.

Objective: To investigate long-term outcomes for men after an initial benign prostate biopsy.

Design, Setting, And Participants: All men with a benign biopsy in the first screening round of the Göteborg prostate cancer (PC) screening trial were included.

Long-Term Outcomes after Deferred Radical Prostatectomy in Men Initially Treated with Active Surveillance.

Purpose: We sought to determine long-term outcomes after deferred radical prostatectomy.

Materials And Methods: The study population consisted of all 132 men with screening detected prostate cancer who underwent deferred radical prostatectomy from January 1, 1995 to December 31, 2014 after active surveillance in the Göteborg Randomized, Population-based Prostate Cancer Screening Trial. The last date of followup was May 15, 2017.

Eighteen-year follow-up of the Göteborg Randomized Population-based Prostate Cancer Screening Trial: effect of sociodemographic variables on participation, prostate cancer incidence and mortality.

Objective: This study examined whether previously reported results, indicating that prostate-specific antigen (PSA) screening can reduce prostate cancer (PC) mortality regardless of sociodemographic inequality, could be corroborated in an 18 year follow-up.

Materials And Methods: In 1994, 20,000 men aged 50-64 years were randomized from the Göteborg population register to PSA screening or control (1:1) (study ID: ISRCTN54449243). Men in the screening group (n = 9950) were invited for biennial PSA testing up to the median age of 69 years.

Long-term Results of Active Surveillance in the Göteborg Randomized, Population-based Prostate Cancer Screening Trial.

Background: Active surveillance (AS) has become a well-accepted and widely used treatment strategy.

Objective: To assess the long-term safety of AS for men with screen-detected prostate cancer (PCa).

Design, Setting, And Participants: All men with screen-detected PCa who had very low-, low-, or intermediate-risk PCa and were managed with AS (January 1, 1995 to December 31, 2014) in the Göteborg screening trial.

Mortality results from the Göteborg randomised population-based prostate-cancer screening trial.

Background: Prostate cancer is one of the leading causes of death from malignant disease among men in the developed world. One strategy to decrease the risk of death from this disease is screening with prostate-specific antigen (PSA); however, the extent of benefit and harm with such screening is under continuous debate.

Methods: In December, 1994, 20,000 men born between 1930 and 1944, randomly sampled from the population register, were randomised by computer in a 1:1 ratio to either a screening group invited for PSA testing every 2 years (n=10,000) or to a control group not invited (n=10,000).

Is delayed radical prostatectomy in men with low-risk screen-detected prostate cancer associated with a higher risk of unfavorable outcomes?

Background: Strategies of active surveillance (AS) of low-risk screen-detected prostate cancer have emerged, because the balance between survival outcomes and quality of life issues when radically treating these malignancies is disputable. Delay before radical treatment caused by active surveillance may be associated with an impaired chance of curability.

Methods: Men diagnosed with low-risk (T1c/T2; prostate-specific antigen [PSA] = <10.

Variability in diagnostic opinion among pathologists for single small atypical foci in prostate biopsies.

Pathologists are increasingly exposed to prostate biopsies with small atypical foci, requiring differentiation between adenocarcinoma, atypical small acinar proliferation suspicious for malignancy, and a benign diagnosis. We studied the level of agreement for such atypical foci among experts in urologic pathology and all-round reference pathologists of the European Randomized Screening study of Prostate Cancer (ERSPC). For this purpose, we retrieved 20 prostate biopsies with small (most <1 mm) atypical foci.

Is tumor vascularity in prostate core biopsies a predictor of PSA recurrence after radical prostatectomy?

The purposes of this study were to evaluate if tumour vascularity by Chalkley counting (TVC) in prostate core biopsies can be a predictor of PSA recurrence after radical prostatectomy in prostate cancer and to estimate the concordance between the TVC in core biopsies and the subsequently examined prostatectomy specimen. All patients, with Gleason score < or =7 in core biopsy, clinical stage T1 or T2 who had a radical prostatectomy during 1990-1997 at Sahlgrenska University Hospital, were selected as a primary group. Patients with neoadjuvant hormonal therapy were excluded.

Interobserver reproducibility of modified Gleason score in radical prostatectomy specimens.

The Gleason score (GS) of prostate cancer is calculated by adding primary and secondary Gleason grades with patterns occupying less than 5% of the tumour often not included despite their probable prognostic significance. A modified Gleason score (mGS) comprising primary and tertiary patterns of higher grade has been proposed, but its interobserver variability has yet to be elucidated. Slides from 69 consecutive prostatectomy specimens were circulated among four genitourinary pathologists.

Interobserver reproducibility of percent Gleason grade 4/5 in prostate biopsies.

Purpose: Percent Gleason grade 4/5 (GG4/5) has been proposed as a predictor of prognosis in prostate cancer and it has been shown to add prognostic information to that given by Gleason score (GS). We recently noted that the interobserver reproducibility of percent GG4/5 in total prostatectomy specimens is at least as good as that of the GS. However, to our knowledge the reproducibility of percent GG4/5 in needle biopsies has not yet been investigated.

Free-to-total prostate-specific antigen ratio as a predictor of non-organ-confined prostate cancer (stage pT3).

Objective: To evaluate whether the free-to-total prostate-specific antigen (F/T-PSA) ratio can be used to differentiate between stage pT2 and pT3 prostate cancer.

Material And Methods: A total of 176 consecutive patients from the Göteborg Screening Study (median T-PSA 4.2 ng/ml) who underwent radical prostatectomy (without neoadjuvant hormonal therapy) were included in the study.

Does initial surveillance in early prostate cancer reduce the chance of cure by radical prostatectomy?--A case control study.

Objective: To evaluate whether initial surveillance followed by prostatectomy impairs pathological stage compared to immediate surgery in men with prostate cancer detected as a result of early screening.

Material And Methods: A total of 26 patients with prostate cancer [T1c-T2, Gleason score <7, prostate-specific antigen (PSA) 3-13 ng/ml] who were managed by means of initial surveillance (mean 23.4 months, range 8-55 months) followed by radical retropubic prostatectomy (RRP) were evaluated.

Prostate specific antigen based biennial screening is sufficient to detect almost all prostate cancers while still curable.

Purpose: We evaluated whether biennial screening with prostate specific antigen (PSA) only is sufficient to detect prostate cancer while still curable.

Materials And Methods: In Göteborg, Sweden 9,972 men 50 to 65 years old were randomized to PSA screening. During 1995 and 1996 these men were invited for a first PSA screening and invited during 1997 and 1998 for a second screening.

Follow-up of men with elevated prostate-specific antigen and one set of benign biopsies at prostate cancer screening.

Objective: To study the follow-up of men with elevated prostate-specific antigen (PSA) (>3 ng/ml) after one benign set of sextant biopsies. From the Göteborg branch of the European Randomised Study of Screening for Prostate Cancer (ERSPC).

Method: 456 men with one set of benign sextant biopsies were followed every second year for 4 years with PSA determinations.

Interobserver reproducibility of percent Gleason grade 4/5 in total prostatectomy specimens.

Purpose: Recently the percent Gleason grade 4/5 was proposed as a predictor of the outcome of prostate cancer and it has been shown that it adds prognostic information to that given by Gleason score. To our knowledge the interobserver variability of percent Gleason grade 4/5 has not yet been investigated. We assessed the percent Gleason grade 4/5, including the identification of high grade patterns and estimation of the percent tumor area, which is potentially more difficult than conventional Gleason grading.