Early detection of prostate diseases Antwerp Protocol
1. Early
detection
The ERSPC study wants to determine the usefullness of early detection
of prostate cancer in men aged 55 to 69. In the mean time the Antwerp
program wants to organise information on benign hyperplasia to be integrated
in general practice.
2. Organisation
In Antwerp the study was organised by the city and the province of Antwerp,
the provincial Institute for Hygiene, the Public center for social welfare
and the Oncological Centre Antwerp in a cooperation with organisations
of GP’s and with the financial support of the Antwerp and European
community.
3. Goals
3.1.
The European program tries to evaluate the serum analysis of Prostate
Specific Antigen (PSA) as a screening tool for prostate cancer in men
aged 55 to 69 years.
3.2.
Within the framework of prevention policy in Flanders we try to develop
implementation of screening and decision making on treatment in primary
health care.
3.3.
Sensitization of policy makers in the field of public health, medical
doctors and the general public for these problems.
3.4.
Implementation of this program in total prevention policy.
4. Method:
randomised screening trial
4.1. Invitation
Men between 55 and 69 years are mailed by the city government with information
about the study. In the letter is explained that participants are randomly
divided into the two groups. Consent for participation to the study
and follow-up is asked. Men who want to participate are randomised.
Their GP is registred. Prior prostate cancer is a reason for exclusion.
4.2. Control
group
The control group is referred to their own GP for routine check-up.
The patient doesn’t need an extra visit for this. The check-up
can happen during a regular visit of the patiënt to his GP since
most people in Belgium visit their GP at least annually.
This check-up can include Digital Rectal Examination (DRE). Digital
rectal examination is considered basic prevention in general practice
for older men in Belgium. Additional examinations are recommended with
abnormal DRE or symptoms that require further investigations. In the
mean time it is usefull to sensitize the patient for general prevention.
4.3. Screening
group
The other half of participants is invited to come to the Oncological
Centre Antwerp, Lange Gasthuisstraat 45, 2000 Antwerp, for DRE and blood
sampling for PSA-analysis. The examinations are done by a GP or a nurse
with several years of experience with this type of examinations. The
individual results are mailed to the GP within 2 weeks.
There are two categories of results:
4.3.1. Normal
If all results are normal the GP gets the test results. If screening
candidates report urinary symptoms (hesitation to urinate, …)
they are also referred to their GP.
4.3.2. Suspected
of prostate cancer
The group of patients with elevated PSA (3 ng/ml or more) or DRE suspect
of prostate cancer receive an invitation for confirmation of the diagnosis
by Trans Rectal Ultrasound (TRUS) guided biopsy. The GP gets a notification
of this extra examination.
4.4. Decision
on therapy
Three weeks after the examination, patients are referred to their GP
for discussion on the results of biopsy. The patient, together with
his GP, decides on treatment if prostate cancer was confirmed by biopsy.
Treatment options are: watchfull waiting (mostly considering age, other
pathology, good differentiation of tumor tissue and cells), radical
surgery, radical radiotherapy or endocrine therapy. |
