[Prostate cancer screening (III): risk factors, natural history, course
without treatment. Characteristics of detected cancers]

Villers A; Soulie M; Haillot O; Boccon-Gibod L
Prog Urol 1997;7(4):655-61
Clinique Esquirol, Agen, France

AB - The Oncology Committee of the Association Fran[caise d'Urologie has
up-dated the knowledge concerning prostatic cancer screening since
the 1989 Consensus Conference. The results are published in the form
of a series of articles referring to the criteria used as prerequisi-
tes for cancer screening programmes. This article reports the data of
the literature concerning risk factors, natural history, course
without treatment and histological characteristics of the cancer
detected. 1) Certain populations have an increased risk due to
genetic factors. A family history (first degree relative) is
associated with a 2- to 3-fold higher risk of prostatic cancer. This
familial aggregation can be used to define a high-risk group
constituting a primary target for screening. 2) The natural history
of the disease, especially the progression from the asymptomatic
stage to the clinical stage and the natural history of the disease at
the clinical stage are now sufficiently well known. The concept of
latent cancer has not been confirmed as the disease inevitably
progresses. Cancers of insignificant volume, less than 0.5 cc
(discovered at autopsy) are classically distinguished from cancers of
significant volume, greater than 0.5 cc, but asymptomatic (risk of
progression with mortality within 15 years), and local and/or
metastatic symptomatic cancers. The histological prevalence of
prostatic cancer is 43% in a group of men with a mean age of 64 years
and increases with age. 92% of histological cancers have a volume
less than 0.5 cc. It takes an estimated 12 years (3 doubling times)
for a 0.5 cc cancer to reach a volume of 4 cc, the volume beyond
which there is a risk of distant metastases. In the absence of
curative treatment, a cancer diagnosed at the localized stage before
the age of 65 years is associated with a specific survival of less
than 30%. The median survival of metastatic prostatic cancer is 2 to
3 years. 3) The disease can be detected at an early stage. Cancers
diagnosed by an isolated elevation of PSA in a screening setting have
a significant volume in more than 3 out of 4 cases, can be entirely
removed by prostatectomy in more than 3 out of 4 cases and have a
less advanced pathological stage than cancers diagnosed on the basis
of classical criteria. (56 Refs)