LAUSR

INTRODUCTION AND OBJECTIVE: To prospectively evaluate a Prostate cancer (PCa) screening program incorporating PSA, Prostate health index (PHI) and MRI in Hong Kong Chinese men. METHODS: This is a 5000-men PCa screening study under the project named Prevention of obesity-related cancer: Setting up of a Multi-cancer education and prevention program in Hong Kong. Since July 2018, Chinese men aged 50-75 years not previously screened for PCa are invited. Screening starts with a PSA determination and men with PSA 4-10ng/mL are tested with the PHI test. A biparametric MRI prostate is offered to men with PSA 4-50ng/mL. A prostate biopsy (systematic, plus targeted if PI-RADS 3) is offered in men with PHI<35 and PI-RADS 3, PHI 35, or PSA 10ng/mL. The cancer detection rate in each group and the role of PHI and MRI is evaluated. Clinically significant PCa (csPCa), is defined as high volume (>20% of number of systematic cores involved) International Society of Urological pathology (ISUP) Grade 1, or ISUP Grade 2 PCa. RESULTS: In the first 1047 men in this study, median age was 63 (IQR61-66), BMI was 25.6 (IQR 23.5-27.7), PSA was 1.43 (IQR 0.84-2.73) ng/mL and 2.7% (28/1042) had first degree family history of PCa. PSA distribution was 86.8% (Group1PSA<4), 6.5% (Group2PSA>4 & PHI<35), 3.9% (Group3PSA>4 &PHI 35), and 2.7% (Group4PSA 10). 7.8% (82/1047) men was offered prostate biopsy and 94% were actually biopsied (n[77). 36.4% (28/77) had PCa and 31.2% (24/77) had csPCa, including 22.1% (17/77) ISUP grade 2 PCa, 5.2% (4/77) cT3, 2.6% (2/77) cN1, and no metastatic disease. Sepsis was reported in 4.5% (3/67) after transrectal biopsy, and 0% (0/10) since all biopsies were changed to transperineal under local anaesthesia. Among men in Group2 with MRI done, 93.5% (58/62) had PI-RADS 2, 3 men had PI-RADS 3 (with 1 non-csPCa diagnosed) and 1 men had PI-RADS 4 (localized ISUP grade 2 PCa). In Group3, 26.8% (11/41) had PCa and 19.5% (8/41) had csPCa (all localized cT2). In Group4, 53.6% (15/28) had PCa and all were csPCa (2 cT3N0 and 2 cT3N1). CONCLUSIONS: A screening algorithm with PSA, PHI and MRI looks able to effectively diagnose csPCa while limiting unnecessary biopsies and diagnosis of non-csPCa. Incorporation of transperineal biopsy could improve risk-benefit ratio in PCa screening by eliminating sepsis.