THE RESULTS OF A 5-YEAR EARLY PROSTATE-CANCER DETECTION INTERVENTION

BACKGROUND. The American Cancer Society-National Prostate Cancer Detec tion Project (ACS-NPCDP) is a multidisciplinary evaluation of early pr ostate cancer detection interventions. This report summarizes the expe rience of the investigators to date and describes the overall and rela tive performance of the different detection modalities studied in this project. METHODS. Two thousand nine hundred ninety-nine men aged 55 t o 70 years at entry who were not already under evaluation for prostate cancer were recruited to participate in up to 5 annual examinations b y prostate specific antigen (PSA), digital rectal examination (DRE), a nd transrectal ultrasound (TRUS). In the course of 5 years of interven tion, ACS-NPCDP investigators have completed 9937 examinations, recomm ended 1215 biopsies, and detected 203 cancers. RESULTS. Loss to cohort follow-up was greatest in the first year. Overall, TRUS led to twice the number of recommendations for biopsy compared with DRE (8.9% versu s 4.4%). Elevated PSA was observed in 13.0% of 9535 measurements perfo rmed. The overall cancer detection rate declined significantly during the five years of intervention. Detection was significantly associated with age and symptom status at entry. DRE had lower sensitivity compa red with TRUS or PSA, particularly in later years of follow-up. The sp ecificity of TRUS was lower than that for DRE, PSA was elevated in 69. 2% of examinations that led to cancer detection, compared with only 10 .9% when cancer was not found. PSA level, PSA density, and PSA change were all related to the presence of cancer. Less than 6% of the cancer s detected in this study were clinically advanced at the time of diagn osis. CONCLUSIONS. These data quantify the yield of early cancer detec tion that may be expected when PSA, DRE, and TRUS are used in populati ons comparable to the men participating in the ACS-NPCDP. Continued fo llow-up and further research is needed to assess whether men receiving early prostate cancer interventions benefit as a result. (C) 1996 Ame rican Cancer Society.