Screening for prostate cancer by digital rectal examination and prostate-specific antigen

Abstract

<h2>Abstract</h2><h3>Objective</h3> To evaluate the use of digital rectal examination (DRE), prostate specific antigen (PSA), and age-specific reference values for PSA when screening for prostate cancer in a national screening program. <h3>Methods</h3> Data collected during Prostate Cancer Awareness Week (PCAW), 1989–1992, were used for comparing DRE and PSA. <h3>Results</h3> More than 1,000,000 men were screened at 4141 sites from 1989–1992. The rate of abnormal DRE for all 4 years was 13.1%, and the rate of elevated PSA (≫4.0 ng/mL) was 14.4% for the same period. PSA proved superior to DRE in sensitivity, positive predictive value, and accuracy in making a cancer diagnosis. Screening resulted in 77.7% of diagnosed cases being determined as clinically localized disease. Age-specific PSA reference values added a slight improvement in sensitivity at lower ages and an improvement in positive predictive value in older men. <h3>Conclusions</h3> Data from PCAW establish the success of national prostate cancerscreening and suggest that further refinements with age-specific PSA reference values may improve overall results.