A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer.

BACKGROUND: The European Randomized study of Screening for Prostate Cancer (ERSPC) has previously demonstrated that prostate-specific antigen (PSA) screening decreases prostate cancer (PCa) mortality. OBJECTIVE: To determine whether PSA screening decreases PCa mortality for up to 16yr and to assess results following adjustment for nonparticipation and the number of screening rounds attended. DESIGN, SETTING, AND PARTICIPANTS: This multicentre population-based randomised screening trial was conducted in eight European countries. Report includes 182160 men, followed up until 2014 (maximum of 16yr), with a predefined core age group of 162389 men (55-69yr), selected from population registry. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The outcome was PCa mortality, also assessed with adjustment for nonparticipation and the number of screening rounds attended. RESULTS AND LIMITATIONS: The rate ratio of PCa mortality was 0.80 (95% confidence interval [CI] 0.72-0.89, p<0.001) at 16yr. The difference in absolute PCa mortality increased from 0.14% at 13yr to 0.18% at 16yr. The number of men needed to be invited for screening to prevent one PCa death was 570 at 16yr compared with 742 at 13yr. The number needed to diagnose was reduced to 18 from 26 at 13yr. Men with PCa detected during the first round had a higher prevalence of PSA >20ng/ml (9.9% compared with 4.1% in the second round, p<0.001) and higher PCa mortality (hazard ratio=1.86, p<0.001) than those detected subsequently. CONCLUSIONS: Findings corroborate earlier results that PSA screening significantly reduces PCa mortality, showing larger absolute benefit with longer follow-up and a reduction in excess incidence. Repeated screening may be important to reduce PCa mortality on a population level. PATIENT SUMMARY: In this report, we looked at the outcomes from prostate cancer in a large European population. We found that repeated screening reduces the risk of dying from prostate cancer.

Hyperprolactinaemia does not always mean 'hyperprolactinaemia'!

The presence of macroprolactinaemia was investigated in the symptom-free hyperprolactinaemia cases to reveal its incidence. The serum prolactin (PRL) fractions in 21 female patients with hyperprolactinaemia without any clinical symptoms were analyzed with PEG (polyethylene glycol precipitation) procedure. In 14 of these 21 cases, hyperprolactinaemia was detected with a high fraction of macroprolactin. In cases with asymptomatic hyperprolactinaemia, it is more appropriate to employ the PEG precipitation test to detect the disorder. High levels of serum prolactin, do not essentially indicate the presence of a prolactinoma but may only indicate macroprolactinaemia.

Qualitative point-of-care and over-the-counter urine hCG devices differentially detect the hCG variants of early pregnancy.

BACKGROUND: Qualitative point-of-care (POC) tests for human chorionic gonadotropin (hCG) vary in their ability to detect purified hCG variants and there is data to suggest that over-the-counter (OTC) devices might also display similar variability. This could potentially influence the detection of urine hCG in early pregnancy. METHODS: Six OTC devices were tested for their ability to detect 5 hCG variants. Ten early pregnancy urine specimens were selected for their diverse expression of hCG variants. The samples were tested with 6 brands of POC and 6 OTC devices. RESULTS: OTC devices consistently recognized intact hCG, hCGn, and hCGbeta. hCGbetan was consistently recognized by 4 out of 6 brands. One brand inconsistently recognized hCGbetacf. OTC and POC devices varied greatly in their ability to detect hCG in early pregnancy urine, despite the fact that urine samples were adjusted to the same intact hCG concentration. Interestingly, we found that the OTC devices had better analytical sensitivity than the POC devices. Clinitest and First Response demonstrated the lowest hCG detection limits for POC and OTC devices, respectively. CONCLUSIONS: Both OTC and POC devices are capable of detecting hCG concentrations in early pregnancy urine, and OTC devices demonstrated better analytical sensitivity relative to POC devices.

Acceptability and complications of prostate biopsy in population-based PSA screening versus routine clinical practice: a prospective, controlled study.

OBJECTIVES: To compare both the acceptability and the complications of prostate biopsy between men attending screening and hospital-referred symptomatic patients. A screening program cannot be successful unless the screening and diagnostic examinations are well tolerated and the willingness to participate is high. METHODS: A total of 200 men, comprising 100 participants in the Finnish prostate cancer screening trial and 100 hospital-referred patients with signs or symptoms suggestive of prostate cancer, were consecutively recruited and underwent transrectal ultrasound-guided prostate biopsies. Immediate complications were recorded at the time of examination. Acceptance and possible late complications of biopsy were requested through a self-administered questionnaire, which was returned by 97% of those screened and 84% of the hospital-referred controls. RESULTS: No major complications were seen immediately after biopsy, but one half of the men had minor rectal hemorrhage and, in a few cases, bleeding from the urethra. Most screened (58%) and hospital-referred (65%) subjects felt no distress before biopsy. The procedure was considered unpleasant by 69% of those screened and 61% of the controls. Correspondingly, 52% and 63% of men reported moderate pain at biopsy, but only 3 of those screened (3%) and 4 controls (5%) experienced severe pain. Nevertheless, a great majority of men in both the screening (82%) and the control (86%) groups would be willing to undergo a repeated biopsy if needed. Persistent rectal bleeding and hematuria were common (13% to 35%, respectively), but less than one fourth considered this disturbing. No significant differences were seen either in complications or acceptability between the groups. CONCLUSIONS: The results of our study demonstrated that minor complications are equally frequent among men undergoing prostate biopsy for screening and other men. Despite the complications, prostate biopsy was regarded as acceptable. Nevertheless, such complications may impair the acceptability, and eventually, the effectiveness of screening.