[How is prostate cancer screening perceived by men 50 to 70 years of age? Analysis based on 1,774 screened individuals]. / Comment le dépistage du cancer de la prostate est-il perçu par les hommes de 50 a 70 ans Analyse a partir de 1774 individus dépistés.

INTRODUCTION: The rationale for mass screening for prostate cancer remains controversial. Apart from the scientific debate, we wanted to evaluate the opinion of prostate cancer screening candidates concerning the practical modalities of this screening and assess the impact of various personal, medical or social factors on their replies. MATERIAL AND METHOD: Following a screening campaign in a French district, 1,774 men, 50 to 70 years of age, who completed screening were interviewed by questionnaire concerning the duration, frequency, mode of blood sampling and the cost of screening. Medical history, family history and lifestyle were also evaluated. RESULTS: Among 1,774 candidates who returned an interpretable questionnaire during the screening campaign (participation rate: 31%), 27.1% of subjects interviewed declared that the personal financial cost would be an obstacle to screening, 5.1% considered that collection of a blood sample from the cubital fossa would be an obstacle to screening, 6.5% considered that one PSA per year was too frequent, and 8.1% considered that screening between the ages of 50 and 70 years was too long. CONCLUSION: More than 90% of men who participated in a prostate cancer screening campaign appear to be in favour of continuation of screening according to the current modalities provided it is free of charge. The acceptance rate was better for men with a family history of prostate cancer, men who had already had a PSA assay, men living alone and men under 60 years of age.

[Impact of obesity on PSA in prostate cancer screening]. / Impact de l'obésité sur le PSA lors du dépistage du cancer de la prostate.

OBJECTIVE: Obesity is associated with changes of serum levels of androgens and oestrogens which could modulate prostate metabolism. The objective of this study was to investigate a possible correlation between the PSA level and the degree of obesity in a candidate population for prostate cancer screening in order to determine whether the PSA level needs to be adapted before performing biopsy. MATERIAL: During a screening campaign in a French district, serum PSA results and body mass index (BMI) were available for 541 men. These men were divided into 4 groups of corpulence: Normal (BMI < 25), Overweight (25 < or = BMI < 30), Stage I obesity (30 < or = BMI < 35), Stage II + III obesity (BMI > or = 35). The PSA levels of these various groups were compared, and a correlation between BMI and PSA was investigated. RESULTS: The mean PSA in each group was inversely proportional to BMI, with mean PSA levels of 3.7, 2.9, 2.6 and 1.5 for Normal, Overweight, Obesity I and Obesity II + III groups, respectively. A significant difference was observed between these groups (p = 0.03) and an inverse correlation was also observed between BMI and PSA (r = 0.1, p = 0.01). CONCLUSION: In a population submitted to prostate cancer screening, PSA is lower as BMI increases. An adaptation of the PSA screening cutoff value according to BMI should be investigated.

Targeted screening for prostate cancer in high risk families: early onset is a significant risk factor for disease in first degree relatives.

PURPOSE: Targeted screening for prostate cancer in high risk families is generally suggested by ages 40 to 45 years in first degree relatives. We support this concept by reporting higher risk and earlier onset of the disease in these families. MATERIALS AND METHODS: We proposed serum prostate specific antigen (PSA) testing in 40 to 70-year-old first degree relatives of 435 patients with prostate cancer treated between July 1994 and June 1997. A previous systematic genealogical analysis allowed us to define the familial prostate cancer status of each patient as sporadic or familial. RESULTS: Of the 747 potential candidates 442 (59%) accepted into the study have been screened, including 240 who were 40 to 49 years old (mean age 44.8) and 202 who were 50 to 70 years old (mean age 57.4). Two of the 240 subjects (0.8%) had PSA greater than 4 ng./ml. in the 40 to 49-year-old group. Prostate biopsies were negative in 1 relative but diagnostic for prostate cancer in the other. In the 50 to 70-year-old group 25 of 202 subjects (12.4%) had a PSA of greater than 4 ng./ml. Prostate cancer was diagnosed in 9 individuals (4.5%), 9 had negative biopsy results, 1 died before biopsy and 6 refused biopsy. The proportion of relatives with PSA greater than 4 ng./ml. and prostate cancer detection was not different according to familial status (sporadic or familial) but it was significantly higher in first degree relatives with early onset prostate cancer in the family at ages younger than 65 years (p = 0.037 and 0.012, respectively). CONCLUSIONS: Our results emphasize the usefulness of PSA screening in high risk families, including those without obvious hereditary features. Furthermore, early onset prostate cancer is a significant risk factor for prostate cancer in first degree relatives.