THE EARLY DETECTION OF PROSTATE CARCINOMA WITH PROSTATE-SPECIFIC ANTIGEN - THE WASHINGTON-UNIVERSITY EXPERIENCE

BACKGROUND. It is not yet known whether screening for the detection of early prostate carcinoma will reduce mortality rates. However, data a re available to assess intermediate outcomes from screening, including the performance characteristics of the screening tests and shifts in disease stage. METHODS. Approximately 30,000 community volunteers (mea n age 60 years; <5% nonwhite) were enrolled in 1 of 3 screening studie s. Volunteers were screened with PSA or PSA in combination with digita l rectal examination at 6-month intervals, and prostatic biopsy was re commended for those with results suspicious for cancer. Based on a fir st-time screen, the current study reports screening test results, the proportion of men recommended to undergo biopsy, the proportion who ac tually underwent biopsy, and the carcinoma detection rates for each st udy, stratified by initial PSA level. The authors also report the path ologic features of screen-detected carcinomas for a subset of men who underwent radical prostatectomy and for whom complete embedding and mi croscopic examination of the surgical specimen was performed. RESULTS. Approximately 10% of the volunteers had PSA levels >4.0 ng/mL and 3-1 0% had digital rectal examination results suspicious for cancer. Overa ll, 9-20% of volunteers were recommended to undergo biopsy and 8-13% a ctually underwent the procedure. The positive predictive value for car cinoma detection ranged from 25-33% across studies. In the subset of m en for whom surgical specimens were completely embedded, the majority of tumors detected had the clinicopathologic features of significant c arcinoma (<10% possibly harmless). CONCLUSIONS. The intermediate outco mes for screening with PSA and/or PSA in combination with digital rect al examination are encouraging. In community volunteers these screenin g tests demonstrated reasonable positive predictive value and detected carcinomas at an earlier stage. The majority of screen-detected tumor s had the pathologic characteristics of medically significant carcinom a. (C) 1997 American Cancer Society.