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Detection of prostate cancer in unselected young men: prospective cohort nested within a randomised controlled trial

Lane, J.A., Howson, J., Donovan, J.L., Goepel, J.R., Dedman, D.J., Down, L., Turner, E.L., Neal, D.E. and Hamdy, F.C. (2007) Detection of prostate cancer in unselected young men: prospective cohort nested within a randomised controlled trial. BMJ, 335 (7630). pp. 1139-1143. ISSN 0959-8146

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Objective: To investigate the feasibility of testing for prostate cancer and the prevalence and characteristics of the disease in unselected young men.

Design: Prospective cohort nested within a randomised controlled trial, with two years of follow-up.

Setting: Eight general practices in a UK city.

Participants: 1299 unselected men aged 45-49.

Intervention: Prostate biopsies for participants with a prostate specific antigen level of 1.5 ng/ml or more and the possibility of randomisation to three treatments for those with localised prostate cancer.

Main outcome measures: Uptake of testing for prostate specific antigen; positive predictive value of prostate specific antigen; and prevalence of prostate cancer, TNM disease stage, and histological grade (Gleason score 6-10). Results 442 of 1299 men agreed to be tested for prostate specific antigen (34%) and 54 (12%) had a raised level. The positive predictive value for prostate specific antigen was 21.3%. Ten cases of prostate cancer were detected (2.31/6) with eight having at least two positive results in biopsy cores and three showing perineural invasion. One tumour was of high volume (cT2c), Gleason score 7, with a positive result on digital rectal examination; nine tumours were cT1c, Gleason score 6, and eight had a negative result on digital rectal examination. Five of the nine eligible participants (55%) agreed to be randomised. No biochemical disease progression occurred in two years of follow-up.

Conclusions: Men younger than 50 will accept testing for prostate cancer but at a much tower rate than older men. Using an age based threshold of 1.5 ng/ml, the prevalence of prostate cancer was similar to that in older men (3.0 ng/ml threshold) and some cancers of potential clinical significance were found.

Item Type: Article
Institution: The University of Sheffield
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine (Sheffield)
Depositing User: Repository Officer
Date Deposited: 03 Nov 2008 19:15
Last Modified: 03 Nov 2008 19:15
Published Version: http://dx.doi.org/10.1136/bmj.39381.436829.BE
Status: Published
Publisher: BMJ Publishing
Refereed: Yes
Identification Number: 10.1136/bmj.39381.436829.BE
URI: http://eprints.whiterose.ac.uk/id/eprint/4812

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