Mass Screening For Prostate Cancer Research Articles

Usefulness of an immunochromatographical assay, PSA Rapid Test as a primary screening test for prostate cancer

The recent rapid increase of mass screening for prostate cancer by measuring PSA in Japan will increase the economic burden to the healthcare system. PSA Rapid Test (PRT) is a simple inexpensive test. The usefulness of PRT as a primary screening test for prostate cancer was evaluated. When we conducted educational lectures for prostate cancer in our city, screening for prostate cancer using PRT was offered to the male participants. The results of the tests were handed to participants in writing at the end of the lectures. When the results were judged as positive, letters of referral to our institute were enclosed. One hundred and fourteen (18.6%) of 614 men were judged as positive by PRT. Of the 114 men with positive PRT, 73 (64%) visited our institution. Finally, 37 men underwent a transrectal prostate biopsy and a diagnosis of prostate cancer was made in 21 men (3.4% of all participants). The total costs for the PSA tests in this study were summed to be approximately $2,300, while they would be approximately $9,200 if all participants had undergone screening using the conventional quantitative method from the outset. PRT is a low-cost method to detect patients with prostate cancer. We believe the PRT is useful as an initial screening test for detecting prostate cancer and that the combination of the PRT and more precise quantitative testing would be a reasonable way to reduce the cost and achieve high detection rate.

Benefit evaluation of mass screening for prostate cancer: Willingness-to-pay measurement using contingent valuation

Objectives Cancer screening exists to save lives. However, the mortality-reducing effect of prostate cancer screening has not yet been sufficiently demonstrated. Therefore, screening should only be performed in men well informed about the disease. We hypothesized that having sufficient information will reduce men’s desire for screening. To verify this hypothesis, we measured the willingness to pay (WTP) for prostate-specific antigen screening using the contingent valuation method. Methods A computer-based questionnaire was implemented through the Internet for 137 men in Japan aged 40 to 59 years. Participants were randomly assigned to two subgroups: 69 subjects were provided with information about the detection rate, and 68 were provided with additional information such as the failure to demonstrate the mortality-reducing effect of prostate-specific antigen screening to date. All were asked about their WTP by a payment cards approach. Results The mean WTP for prostate-specific antigen screening was $18.90. Categorical regression analysis suggested that annual income, age, and hospitalization history were factors affecting the WTP. Unexpectedly, the difference in the mean WTP between the ill-informed and well-informed groups was not statistically significant. Conclusions The contingent valuation method can quantify comprehensive benefits, including not only health outcomes, but also non-health outcomes such as reassurance value. The subjects were not so concerned about the long-term effectiveness of saving lives. Their greatest concern was the detection rate. Their WTP may have reflected their desire for the reassurance that could be obtained by confirming that they had no physical sign of cancer.

Mass screening for prostate cancer in patients with end‐stage renal disease: a comparative study

To determine the usefulness of prostate-specific antigen (PSA) screening for prostate cancer in patients with end-stage renal disease (ESRD), as although serum PSA is effective in the early detection of this cancer in the general population, there are few reports of its utility in patients with ESRD. Blood samples were obtained for PSA screening from April 2002 to September 2003; 1250 men with ESRD aged >50 years were compared with 1007 healthy control men aged >55 years, all in Kumamoto Prefecture, Japan. All men with a serum PSA level of >4.0 ng/mL were categorized as PSA-positive and were further assessed, including a prostate biopsy. There was a statistically significantly greater increase in PSA level with age in the ESRD group than in the healthy controls. The rate of cancer detection among men with a PSA level of >10 ng/mL was significantly higher in patients with ESRD than in healthy controls. Thirteen patients with ESRD and five healthy control men were finally diagnosed with prostate cancer. The serum PSA level was slightly higher and the incidence of prostate cancer at higher PSA levels appeared to be greater in men with ESRD than in healthy controls. The findings of this large study suggest that PSA screening is useful for the diagnosis of prostate cancer in these patients.

Lower urinary tract symptoms and risk of prostate cancer in Japanese men

Our aim was to investigate whether or not men with lower urinary tract symptoms are at increased risk of prostate cancer. A total of 3511 men aged 50-79 years who underwent mass screening for prostate cancer between 2002 and 2004 for the first time, and completed the International Prostate Symptom Score (IPSS) questionnaire at the time of the prostate specific antigen (PSA) test, were enrolled in the present study. All men with PSA values greater than 4.0 ng/mL were advised and encouraged to undergo transrectal systematic sextant biopsy. The number of cancers subsequently detected was compared between men with IPSS scores of 0-7 and 8-35. Of the 3511 men, 219 (6.2%) had PSA values greater than 4 ng/mL, 178 (5.1%) underwent biopsy, and 51 (1.5%) were found to have prostate cancer. Although the PSA positivity rate for men with IPSS scores of 8-35 was significantly higher than that in the 0-7 group, there were no significant intergroup differences in the cancer detection rates for biopsied men and for total screened subjects. Multivariate logistic regression analysis revealed that prostate volume was the dominant predictor for the detection of prostate cancer, followed by PSA level, but the IPSS made no significant contribution. No significant difference was noted in the IPSS scores between men with cancer and the others of the same age group. Symptomatic Japanese men are not at higher risk of prostate cancer despite their higher PSA values compared with asymptomatic men of the same age group.

Dépistage du cancer de la prostate : synthèse

Screening for prostate cancer (PCa) remains a matter of debate. Although the results of two ongoing randomised trials will be available in 2008, mass screening of PCa is already effective in the United States where PCa-related mortality has very significantly decreased. However, such screening is strongly suspected to induce "over-diagnosis". This results in the treatment of insignificant PCa, but in a significant complication rate. This situation finds an explanation in the low specificity of PSA, the screening tool for aggressive PCa. All of the debate is based on a misunderstanding between the pros and the cons of screening. On one hand, if diagnosis is considered a search for knowledge, then advocate an "over-diagnosis" would mean advocate an "over-knowledge", which is nonsense. On the other hand, if treatment is considered a search for action on the natural history of a disease, then advocate an "over-treatment" would mean advocate an "over-action", which is meaningful. The problem induced by screening is not to search for a disease, but what we do with it when we find it! Before recommending mass screening for PCa, we have to re-educate our patients in their understanding of the disease and re-educate ourselves in our treatment decision process. Waiting for a governmental decision about PCa screening policy, one should actually consider individual screening, which allows for personal education of patients.

Mass screening of prostate cancer in a Chinese population: the relationship between pathological features of prostate cancer and serum prostate specific antigen

To investigate the pathological features of the prostate biopsy through mass screening for prostate cancer in a Chinese cohort and their association with serum prostate specific antigen (PSA). A total of 12027 Chinese men in Changchun were screened for prostate cancer by means of the serum total prostate specific antigen tPSA test (by Elisa assay). Transrectal ultrasound-guided systematic six-sextant biopsies were performed on those whose serum tPSA value was > 4.0 ng/mL and those who had obstructive symptoms (despite their tPSA value) and were subject to subsequent pathological analysis with the aid of the statistic software SPSS 10.0 (SPSS. Inc., Chicago. USA). Of the 12027 cases, 158 (including 137 patients whose serum tPSA values were 4.0 ng/mL and 21 patients [serum tPSA < 4.0 ng/mL] who had obstructive symptoms) undertook prostate biopsy. Of the 158 biopsies, 41 cases of prostatic carcinoma were found (25.9 %, 41/158). The moderately differentiated carcinoma and poorly differentiated carcinoma accounted for 61% and 34%, respectively. A significant linear positive correlation between the serum tPSA and the Gleason scores in the 41 cases of prostatic carcinoma (r = 0.312, P < 0.01) was established. A significant linear positive correlation between the serum tPSA value of the 41 prostatic carcinoma and the positive counts of carcinoma in sextant biopsies was established (r = 0.406, P < 0.01), indicating a significant linear relationship between serum tPSA and the size of tumor. This study was the first to conduct mass screening for prostate cancer by testing for serum tPSA values and the first to investigate the pathological features of prostate cancer in a cohort of Chinese men. Our results reveal that the moderately differentiated carcinoma is the most common type of prostate cancer. This study also has shown that the serum tPSA value in prostate cancer is associated with the Gleason score and the size of tumor.

A Markov model for optimal intervals in prostate cancer screening programs in the era of individual baseline PSA values

4618 Background: Once a prostate cancer screening program using prostate-specific antigen (PSA) has been established and is operational, the issue of the re-screening interval for patients with prior negative PSA results comes into question. We approached this issue using a decision-analytic model in which participants were stratified by baseline PSA values. Methods: Based on an actual contemporary screening program, we established a Markov decision analytic model of prostate cancer screening with different re-screening interval strategies determined by individual baseline PSA levels. Cost-effectiveness analysis was performed to determine the incremental cost-effectiveness ratio (ICER; costs per quality-adjusted life years) for each strategy. Results: Re-screening strategies with biennial PSA testing in men with PSA levels ≤3.0 and ≤4.0 ng/ml are dominated by biennial screening in men with PSA ≤2.0 ng/ml, which is the most cost-effective strategy. ICERs for annual screening and biennial screening strategies in men with PSA ≤1.0 were US$25,220 and US$10,557, respectively, with respect to strategies with biennial screening in men with PSA ≤2.0 ng/ml. On sensitivity analyses, ICER for annual screening with respect to biennial screening in men with PSA ≤2.0 ng/ml will be larger under conditions with a lower biopsy participation rate in PSA-positive participants, or a lower cancer detection rate on biopsy. It was also observed that ICER for an annual screening strategy is larger in an initial age cohort of men in their 50’s and 70’s than in their 60’s. Conclusions: Our model shows that cut off of baseline PSA for annual PSA testing in prostate cancer mass screening should be determined as 0.0 to 2.0 ng/ml based on clinical and economical variables in view of the budget of each society. No significant financial relationships to disclose.

Mass screening of prostate cancer in Changchun City of China

Mass screening of prostate cancer in China had not been studied until now. To clarify the incidence of prostate cancer among the population of aged men in Changchun City of China, we performed a mass screening program for prostate cancer using prostate specific antigen (PSA). Men aged more than 50 years were examined by PSA, with a cut-off values 4.1 ng/ml. Subjects, whose serum PSA concentration was more than 4.1 ng/ml, were recommended to secondary examination of transrectal ultrasound-guided systematic six-sextant biopsy examination (TRUS-guided biopsy). Between April 1998 and December 2000, in the urban area of Changchun City 4218 men over 50 years old were screened. As 190 men were found to have elevated PSA and 116 men underwent a TRUS-guided biopsy of the prostate, of whom 29 men were found to have cancer. In all, the age-adjusted PSA positive rate was 4.80%, cancer detection rate was 0.74%. The age-adjusted cancer detection rate was 0.78%. After adjusted for secondary examination rate, the cancer detection rate reached 1.28%. The cases of stage B with limited cancer within the prostate gland, accounted for 62% of 29 cancer cases. Stage B was much more detected (accounted for 60%) in the PSA range of 4.1-10.0 ng/ml. Stage C and D were much more detected (accounted for 85.71%) in the PSA range over 10.1 ng/ml, with a significant difference by Fisher exact test (P < 0.05). A significant correlation of age-adjusted PSA positive rate and age-adjusted cancer detection rate adjusted by secondary examination rate was showed in six groups of Community and Army, Factory, Corporation, Post and Telecom Office, Government and Academy, and University and Technical School (r = 0.898, P < 0.01). Both of the age-adjusted PSA positive rate and age-adjusted cancer detect rate of "Universities and Technical Schools" were significantly higher than that of "Factories" (chi2 test P < 0.05). The prevalence of prostate cancer was not so low in Chinese people as expected. For 50 years or older men, cancer detection rate was 0.74%, The age-adjusted cancer detect rate was 0.78%. Much more early stage cancer could be detected in the screening using serum PSA. For the different company the detection rate of prostate cancer varied each other among the groups. Age-adjusted cancer detection rate in "Universities and Technical Schools" were significantly higher than in "Factories", suggesting environment factor or diet might be associated with the prostate cancer.

Primary symptoms of 301 patients with prostate cancer: Nagoya Urology Hospital experience

Primary symptoms were reviewed retrospectively in patients with prostate cancer diagnosed in our hospital with the aim of promoting early detection. The subjects included 301 cases with prostate cancer diagnosed histologically in Nagoya Urology Hospital from August, 1988 to December, 2001. The mean age was 72.7 years, and the median PSA was 20.0 ng/ml. Primary symptoms were classified according to the General Rule for Clinical and Pathological Studies on Prostate Cancer (The 3rd Edition). Out of 301 cases, 274 (91%) visited our hospital with clinical symptoms. Of them, 272 had primary urological symptoms. In these 272 cases, 250 (92%) and 19 (7%) had lower urinary tract symptoms (LUTS) and macroscopic or microscopic hematuria, respectively. The majority of patients (82%) referred from other urologists had already undergone PSA measurement, compared to 50% in those referred from physicians other than urologists (p < 0.0005). The present data revealed that LUTS were important primary symptoms for the detection of prostate cancer, particularly in an area like Nagoya where the mass screening for prostate cancer is still unavailable. In terms of the early detection of prostate cancer, PSA has to be measured in patients with LUTS even when they visit physicians who are not urologists.

Mass screening for prostate cancer: a comparative study in Natori, Japan and Changchun, China

Objectives To study the natural background of prostate cancer in Japan and China, mass checks with prostate-specific antigen (PSA)-based screenings were performed using identical procedures in Natori, Japan and Changchun, China. Methods For 7 years (1995 to 2001) in Natori, Japan, and for 3 years (1998 to 2000) in Changchun, China, 2212 Japanese and 3566 Chinese men older than 55 years were mass checked by PSA-based screening (serum PSA cutoff value 4.1 ng/mL). Results The PSA-positive rates (PSA 4.1 ng/mL or greater) and cancer detection rates in the screened persons of Natori and Changchun were 8.5% and 5.2% ( P <0.0005) and 2.1% and 0.8% ( P <0.0001), respectively. When the number of cancer cases detected was adjusted to a 100% biopsy rate for men who were PSA positive in both cities, the cancer detection rate was estimated at 2.3% and 1.3% in Natori and Changchun, respectively. This difference was also significant ( P <0.01). Conclusions The results indicate that the percentage of PSA-positive men 55 years or older in Changchun was lower than that in Natori. The analysis of the results suggests that the prostate cancer incidence and prevalence in Changchun, China are lower than those in Natori, Japan.

Cost effectiveness of screening procedures for early detection of prostatic carcinoma: an overview

The authors attempted to provide an overview of current concepts and the status of research in the field of cost effectiveness analysis (CEA) of screening for prostate cancer (PCA). Basic concepts and methods of CEA were reviewed. Examples of CEA-related studies of PCA were obtained from pertinent literature through medical databases. Screening for PCA has so far been restricted to limited groups of health care recipients, usually within the framework of clinical trials. In those trials, screening for PCA usually results in higher numbers of PCAs being detected at lower average stages in a given population. As a consequence of screening, the rate of potentially curable PCAs increases. However, it has not yet been demonstrated that screening for PCA decreases PCA-related mortality or morbidity from metastatic PCA. On the other hand, additional costs are associated with the screening measure and with increased use of resources for diagnosis and treatment of the additional PCAs detected through screening. Throughout the European Union and North America, mass screening for PCA has not been implemented. This may chiefly be due to the current lack of information on long term benefits of PCA screening, particularly disease-specific survival. Currently, major studies are underway to assess the effects of PCA screening and its cost effectiveness. These studies include the US-American prostate, lung, colon and ovary trials (PLCO) and the European randomised study of Screening for Prostate Cancer (ERSPC).

Usefulness of prostate-specific antigen velocity in screening for prostate cancer.

The cut-off value of prostate-specific antigen velocity (PSAV) was investigated in relation to the initial prostate-specific antigen (PSA) value in subjects with initial values of 1.0-4.0 ng/mL, and the usefulness and limitations of PSAV as a screening test for prostate cancer were examined. In this study, 4883 men who underwent mass screening for prostate cancer two or more times between 1987 and 1998 and had initial PSA levels of 1.0-4.0 ng/mL were investigated. The subjects ranged in age from 42 to 96 years (mean: 68.0 +/- 6.6 years). The cut-off value of PSAV was set at 0.1-1.5 ng/mL per year, and the sensitivity, specificity, efficiency and positive predictive value (PPV) of PSAV for detecting prostate cancer were determined according to the initial PSA value. A similar examination of the average PSAV was carried out in 2888 subjects with three or more visits for mass screening for prostate cancer. The diagnostic efficiency of PSAV was optimal with cut-off values of 0.3 and 0.75 ng/mL per year in those subjects with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively, but the PPV was low at 1.8% in subjects with initial PSA levels of 1.0-1.9 ng/mL. When the cutoff value of PSAV was set at 1.2 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 ng/mL, the PPV increased to 7.3% and the sensitivity was 40%. The diagnostic efficiency of the average PSAV was optimal at the cut-off values of 0.2 and 0.4 ng/mL per year in subjects with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively, but the PPV was low at 2.2% in the subjects with initial PSA values of 1.0-1.9 ng/mL. When the cut-off value of PSAV was set at 0.75 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 ng/mL, the PPV was 9.8% and the sensitivity was 46%. It is possible to improve the diagnostic accuracy of prostate cancer screening using the cut-off value of PSAV and average PSAV in subjects with initial PSA levels of 1.0-4.0 ng/mL. The cut-off values of PSAV should be set at 1.2 and 0.75 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively. The cut-off values of the average PSAV should be set at 0.75 and 0.4 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively.

Relevance of PSA-nanotest on capillary blood in organised mass screening of prostate cancer

Relevance of PSA-nanotest on capillary blood in organised mass screening of prostate cancer

Ethnic differences in the age-related distribution of serum prostate-specific antigen values: a study in a healthy Korean male population

Objectives. To further improve the use of prostate-specific antigen (PSA) as a screening test for prostate cancer in Asian countries, we sought to establish the normal distribution of serum PSA values in Korean men, because, until recently, studies conducted to establish normal serum PSA values have involved few Asian populations. Methods. Between May 1995 and June 1997, 5805 healthy Korean men 30 to 79 years old who visited our hospital for a routine health checkup were entered into a prospective study of early screening for prostate cancer. All men underwent detailed clinical examinations, including a digital rectal examination and serum PSA determination. All men who were more than 50 years old with abnormal digital rectal examination findings and/or an elevated serum PSA level (greater than 4.0 ng/mL) also underwent transrectal ultrasound-guided sextant biopsy. Four were found to have cancer and were excluded from the analysis. Results. The median serum PSA concentration (5th to 95th percentile range) was 0.8 ng/mL (0.2 to 1.8) for patients 30 to 39 years old (n = 1382); 0.8 ng/mL (0.2 to 2.0) for patients 40 to 49 years old (n = 1776); 0.9 ng/mL (0.2 to 2.4) for those 50 to 59 years old (n = 1775); 1.0 ng/mL (0.2 to 3.9) for men 60 to 69 years old (n = 746); and 1.3 ng/mL (0.5 to 6.3) for patients 70 to 79 years old (n = 122). The serum PSA concentration correlated with age ( P <0.001), with an increase by approximately 1.2% annually, although the statistical correlation was weak ( r = 0.16). Almost no change occurred in the median serum PSA value in patients 50 years old or younger; a gradual increase was observed in patients older than 50. In those 50 years old or older, the median and 95th percentile serum PSA values for Korean men were lower than those for white men. Conclusions. Contrary to earlier observations that the serum PSA level strongly correlates with age, the influence of age on serum PSA was found to be weaker in this study. Moreover, the results also demonstrated that the distribution of the serum PSA level differs along ethnic lines. The cutoff value for serum PSA in mass screening for prostate cancer should be adjusted in nonwhite races.

Usefulness of age-specific reference range of prostate-specific antigen for japanese men older than 60 years in mass screening for prostate cancer

Objectives. To investigate the age-specific reference range of prostate-specific antigen (PSA) in Japanese men older than 60 years of age by analyzing the receiver operating characteristic (ROC) curve. Several reports have noted that many clinically serious cancers are missed by raising the cutoff value of the age-specific PSA reference range for men older than 60 years. Methods. We studied 6744 individuals who had undergone mass screening for prostate cancer in Gunma Prefecture from 1994 to 1998. PSA determination was the first step of the mass screening in all subjects. Digital rectal examination and transrectal ultrasonography (TRUS) were performed in all except in a fraction of patients. Subjects with an abnormal PSA level or abnormal digital rectal examination or TRUS findings underwent TRUS-guided systematic sextant biopsies. Patients older than 60 years of age were grouped according to their age at 5-year intervals, and the cutoff value of the age-specific PSA reference range was calculated for each age group by analyzing the ROC curve. Results. The diagnostic efficiency of the age-specific PSA reference range was optimal with cutoff values of 3.0, 3.5, 4.0, 4.0, and 7.0 ng/mL in subjects 60 to 64, 65 to 69, 70 to 74, 75 to 79, and older than 80 years of age, respectively. By using the age-specific PSA reference range as determined by the ROC curve, the sensitivity, specificity, and efficiency increased to 92.4%, 91.2%, and 84.3%, respectively. When the standard PSA reference range was used for the diagnosis, the sensitivity, specificity, and efficiency was 89.1%, 92.4%, and 82.3%, respectively. All of the cases of prostate cancer detected by using the age-specific PSA reference range with the cutoff point based on the ROC curves were clinically significant. Conclusions. The age-specific PSA reference range cutoff value in this setting demonstrated better diagnostic efficiency than the standard cutoff value of PSA and the age-specific PSA reference range determined by the 95% confidence interval. It appears likely to be a useful diagnostic index for the first step of mass screening in Japanese men.

Correlation of prostate-specific antigen before prostate cancer detection and clinicopathologic features: evaluation of mass screening populations

Objectives. Although prostate-specific antigen (PSA) has become the reference standard for prostate cancer diagnosis, few reports have examined the long-term changes in PSA values before the diagnosis of prostate cancer in a large number of subjects. We investigated serial PSA levels and related values before prostate cancer diagnosis in a mass screening population and analyzed the values in an attempt to discover some values useful in clinical diagnostic science. Methods. We performed mass screening for prostate cancer in 9671 subjects from 1986 to 1998. The initial screening method was measurement of prostatic acid phosphatase from 1986 to 1991 and measurement of PSA from 1992 to 1998. As a result, 303 cases of prostate cancer were diagnosed. For all the cases diagnosed before 1991, we measured the serum PSA value in preserved frozen serum. Results. The prostate cancer detection rate was 3.1% among all subjects observed during the 13-year period. By measurement of the PSA level using frozen serum during the pre-PSA era, we found that 62% of patients demonstrated a PSA abnormality for more than 1 year (average 2.8) before prostate cancer diagnosis. Prostate cancer that was diagnosed within 1 year after a PSA value became abnormal was not associated with bone metastasis. Concerning the relationship between PSA velocity (PSAV) and clinical stage, the proportion of Stage B cancer was 86% in the subjects whose PSAV level before diagnosis was 0.18 ng/mL/yr or less and it was only 29% in those with PSAV levels of 4.5 ng/mL/yr or more. Only 3 (3.5%) of 86 patients with prostate cancer with PSAV levels of 4.4 ng/mL/yr or less had bone metastasis, and 2 of those 3 patients had poorly differentiated adenocarcinoma. Conclusions. Although a total of 62% of patients had an abnormal PSA level more than 1 year before prostate cancer diagnosis, no patients with prostate cancer who were diagnosed within 1 year after the PSA level became abnormal had bone metastasis. Among patients who have undergone mass screening twice or more, a clinically useful indicator of the lack of bone metastasis would be a period between the detection of PSA levels of 4.1 ng/mL or more but not more than 10 ng/mL and prostate cancer diagnosis of less than 1 year and a diagnosis of well or moderately differentiated adenocarcinoma or a PSAV of 4.4 ng/mL/yr or less and a cancer diagnosis of well or moderately differentiated adenocarcinoma.

Mass Screening for Prostate Cancer

To screen or not to screen for prostate cancer remains a controversial question. The increasing incidence, for a large part explained by a rising awareness and active search for the disease, and the slightly increasing mortality, presumably real, unquestionably call for intensified efforts to improve the control of prostate cancer. When the patients become symptomatic they are usually out of the reach of radical treatment. Cure of the disease, if cure is possible, can be hoped for only in case the patient is identified in the asymptomatic stage.

Accuracy of Diagnosis for Prostate Cancer

The accuracy of prostate cancer (PCA) diagnosis was evaluated in the subjects examined by mass screening for prostate cancer. We investigated the accuracy by the follow-up study and the Prostate Cancer Registry in Gunma Prefecture. The cause of incorrect diagnosis was stratified into 4 groups: [1] the incorrect diagnosis at mass screening, [2] the incorrect diagnosis by urologists at the hospital, [3] the biopsy-rejection by subjects with abnormal examination, and [4] incorrect diagnosis by prostate biopsy. We also analyzed the period from the initial diagnosis to the cancer confirmation and clinical stage at the time of pathological cancer-confirmation. Although it was difficult to distinguish newly developed cancer from incorrectly diagnosed cancer, it is expected that this study will demonstrate the adequate interval between screenings and how to improve the diagnostic accuracy.

Diagnostic Significance of Prostate Specific Antigen and the Development of Mass Screening System for Prostate Cancer

Purpose The significance of prostate specific antigen (PSA) in the mass screening for prostate cancer was investigated. Materials and Methods A total of 4,375 PSA, digital rectal and transrectal ultrasonographic examinations was performed on 3,526 subjects. Results Among the 3 modalities, PSA had the highest sensitivity (80.4 percent) and positive predictive value (45.1 percent). We established age-specific reference PSA ranges for normal Japanese men, and demonstrated the significance of PSA density and PSA velocity. Conclusions The significance of PSA as a prostate cancer screening modality should be evaluated across multiple age ranges and in combination with previous PSA data and/or prostate volume.

Prostate-specific antigen in mass screening for carcinoma of the prostate.

Prostate-specific antigen (PSA) has various advantages over prostatic acid phosphatase (PAP) as a marker for prostate cancer, but its role in prostate cancer mass screening remains controversial. We measured serum PSA in addition to serum PAP determination and digital rectal examination (DRE) in our mass screening program to assess the usefulness of PSA for prostate cancer mass screening. Serum PSA and PAP measurements and DRE were performed in 1249 patients in mass screening for carcinoma of the prostate in 1989 and 1990. Thirteen cancers were diagnosed. We calculated the mean plus standard deviations (2SD) of the PSA and PAP values of men without cancer, and assessed the usefulness of PSA for prostate cancer screening by using these figures as the upper limit of normal. The number positive for PSA, PAP and DRE were 39, 36 and 48, respectively. If our screening had been performed without DRE, three cancers would have remained undetected, and the number would have been the same if performed without PSA. If the screening had been performed without PAP, on the other hand, no cancers would have remained undetected. The sensitivities of PSA and PAP were 54% and 23%, respectively. The screening detection rate with DRE and PSA was 0.88%, and with DRE and PAP was 0.64%. Measurement of serum PSA values with adjustment of the cut-off value was considered more useful than PAP in mass screening for prostate cancer.