Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening.

OBJECTIVE To determine whether prostate-specific antigen (PSA)-based screening alters the proportion of organ-confined prostate cancers detected. DESIGN A prospective, nonrandomized, serial PSA-based screening trial (follow-up from 6 to 37 months), and a concurrent comparison group. SETTING General community outpatient screening program based at a university center. PATIENTS The study group consisted of 10,251 men aged 50 years and older (mean and median age, 63 years; mean and median age of patients who underwent biopsies, 66 years) who presented to a prostate cancer screening program and consented to phlebotomy. The comparison group consisted of 266 concurrently studied private patients in the same age range (mean and median age, 68 years) who were referred for prostatic ultrasonography and biopsy because of an abnormal digital rectal examination (DRE). MAIN OUTCOME MEASURE Proportion detected with clinically or pathologically advanced prostate cancer. RESULTS The men were divided into three groups: the comparison group, the initial PSA-based screening group, and the serial PSA-based screening group. The proportions of prostate cancers detected that were clinically or pathologically advanced were as follows: comparison group, 57% (27/47); initial PSA-based screening group, 37% (91/244); and serial PSA-based screening group, 29% (37/129). Screened patients had a lower proportion of advanced cancers than the comparison group (chi 2 [2] = 12.3; P = .002); this advantage was observed principally in patients younger than 70 years. Surgical staging revealed that the cancer was microscopically focal and well differentiated (possibly latent cancer) in 2.5% (1/40) of the nonscreened group, 2.9% (7/244) of the initially screened group, and 7.8% (10/129) of the serially screened group (generalized Fisher's Exact Test, P = .08). CONCLUSION Screening based on PSA identifies some men with prostate cancer who have a significantly increased proportion of organ-confined tumors compared with those detected through evaluation for an abnormal DRE alone.

[1]  W. Catalona,et al.  Prevalence and pathological extent of prostate cancer in men with prostate specific antigen levels of 2.9 to 4.0 ng./ml. , 1993, The Journal of urology.

[2]  I. Thompson,et al.  Disease-specific survival following routine prostate cancer screening by digital rectal examination. , 1993, JAMA.

[3]  J. Oesterling,et al.  Clinical Stage B0 or T1c prostate cancer: nonpalpable disease identified by elevated serum prostate-specific antigen concentration. , 1993, Urology.

[4]  T. Tong,et al.  Cancer statistics, 1993 , 1993, CA: a cancer journal for clinicians.

[5]  E. Metter,et al.  Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. , 1992, JAMA.

[6]  R. Vessella,et al.  Screening for prostatic carcinoma with prostate specific antigen. , 1992, The Journal of urology.

[7]  J. McNeal.  Cancer volume and site of origin of adenocarcinoma in the prostate: relationship to local and distant spread. , 1992, Human pathology.

[8]  M. Riggs,et al.  Prostate‐specific antigen levels from completely sectioned, clinically benign, whole prostates , 1991, Cancer.

[9]  W. Catalona,et al.  Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. , 1991, The New England journal of medicine.

[10]  W. Cooner,et al.  Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. , 1990, The Journal of urology.

[11]  J. Oesterling,et al.  Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia. , 1990, The Journal of urology.

[12]  W. Catalona,et al.  Nerve-sparing radical prostatectomy: evaluation of results after 250 patients. , 1990, The Journal of urology.

[13]  W. Catalona.  Re: Pathological stage is higher in older men with clinical stage B1 adenocarcinoma of the prostate. , 1990, The Journal of urology.

[14]  W. Catalona,et al.  Clinical use of prostate specific antigen in patients with prostate cancer. , 1989, The Journal of urology.

[15]  G. Chodak,et al.  Assessment of screening for prostate cancer using the digital rectal examination. , 1989, The Journal of urology.

[16]  P. Walsh,et al.  Pathological stage is higher in older men with clinical stage B1 adenocarcinoma of the prostate. , 1989, The Journal of urology.

[17]  J. Oesterling,et al.  Prostate specific antigen in the preoperative and postoperative evaluation of localized prostatic cancer treated with radical prostatectomy. , 1988, The Journal of urology.

[18]  T. Stamey,et al.  Prostate-Specific Antigen as a Serum Marker for Adenocarcinoma of the Prostate , 1987 .

[19]  I. Thompson,et al.  Impact of routine screening for adenocarcinoma of the prostate on stage distribution. , 1987, The Journal of urology.

[20]  F. Lee,et al.  Transrectal ultrasound in the diagnosis of prostate cancer: Location, echogenicity, histopathology, and staging , 1986, The Prostate.

[21]  Nitin R. Patel,et al.  A Network Algorithm for Performing Fisher's Exact Test in r × c Contingency Tables , 1983 .

[22]  L. A. Marascuilo,et al.  Nonparametric and Distribution-Free Methods for the Social Sciences , 1977 .