OBSERVATIONS ON THE EARLY DETECTION OF PROSTATE-CANCER FROM THE AMERICAN-CANCER-SOCIETY NATIONAL PROSTATE-CANCER DETECTION PROJECT

BACKGROUND. The American Cancer Society National Prostate Cancer Detec tion Project (ACS-NPCDP) was established in 1987. The experience of th e ACS-NPCDP demonstrates the yield and impact of periodic examinations for the early detection of prostate cancer. METHODS. A cohort of 2999 well men ages 55-70 years was tested annually at 10 clinical centers by prostate specific antigen (PSA), transrectal ultrasound (TRUS), and digital rectal examination (DRE). Biopsies were performed on men with suspicious findings. Pathologic findings were reviewed. The initial s tudy outcomes were the detection yield of multimodality testing and th e comparative sensitivity and specificity of the different tests emplo yed. Longer term outcomes included patient quality of life and surviva l. RESULTS. The cancer detection rate declined significantly across th e years of intervention. DRE had lower sensitivity than TRUS or PSA, p articularly in later years of followup. The specificity of TRUS was lo wer than that of DRE. Fewer than 9% of the cancers detected in this st udy were clinically advanced at the time of diagnosis. Ninety-four per cent of patients in whom cancer was detected are alive after an averag e follow-up of 54 months. In one case, death occurred after surgery. T wo deaths were attributed to prostate cancer, and eleven other deaths were unrelated to prostate cancer or its treatment. CONCLUSIONS. Resul ts of the ACS-NPCDP indicate that a combined-modality approach to pros tate cancer detection yields high levels of early detection with infre quent adverse outcomes. Continued follow-up is required to evaluate lo ng term morbidity and mortality. (C) 1997 American Cancer Society.