Editorial comment: (Prostate specific antigen changes as related to the initial prostate specific antigen: Data from the prostate, lung, colorectal and ovarian cancer screening trial)

The data (coming from the prostate arm of the PLCO) from several consecutive yearly screening visits show that a standard yearly screening visit for every man results in a number of additional visits with comparable results with respect to serum PSA level. Therefore, it is concluded that a screening interval can be prolonged, especially in men with low PSA levels (less than 2.0 ng/ml). Since this group of men form a considerable part (80.5%) of the screened population (men 55 to 74 years old), this will lead to a considerable reduction in PSA tests and corresponding costs. The data are similar to those of the European Randomized Study of Screening for Prostate Cancer (reference 16 in article).1 With the data of Thompson et al,2 it became clear that prostate cancer is present in all PSA ranges and also prostate cancer considered as clinically significant. This could lead to the conclusion that the serum PSA cutoff for prostate biopsy must be lowered. This is especially relevant in the PSA range of 2.0 to 2.9 ng/ml, a range that is not yet considered a trigger point for systematic prostate biopsy regardless of DRE and/or transrectal ultrasound results, although Krumholtz et al suggested lowering the PSA cutoff for prostate biopsy to 2.6 ng/ml.3 If we focus on the cancers detected with Gleason scores 7 to 10 in the PLCO data set we can calculate a detection rate of 2.5%, 6.3% and 8% for baseline PSA ranges 0 to 1, 1 to 2 and 2 to 3 ng/ml, respectively. It would be interesting to further explore the value of all available pre-biopsy information of Gleason 7 to 10 cancer cases in this particular cohort. Simply rescreening every year or lowering the PSA cutoff for a prostate biopsy will increase not only costs but also the diagnosis of cancers that might possibly be detected at a curable stage later in time or cancers that do not need to be detected at all.