THE VALUE OF PROSTATE-SPECIFIC ANTIGEN IN EARLY DIAGNOSIS OF PROSTATE-CANCER - THE STUDY OF MEN BORN IN 1913

Purpose: We attempt to elucidate the performance of serum prostate spe cific antigen (PSA) as a screening test for prostate cancer. Materials and Methods: We analyzed sera stored since 1980 in a nested case-cont rol study. Results: The 36 patients with prostate cancer had a markedl y greater mean serum PSA level than did 68 subjects without cancer (22 .71 versus 2.67, respectively, p <0.0001). Among the controls 24% had a serum PSA of greater than 4.0 mu g./l. A serum PSA value exceeding 4 .0 mu g./l. in 1980 was associated with a 20-fold excess risk of cance r between 1981 and 1986, and an 8-fold risk between 1987 and 1991. Con clusions: Diagnosis of clinically significant prostate cancer can be a dvanced substantially by serum PSA testing. However, the large number of high serum PSA values in men who remained free of clinical disease emphasizes the need for a more specific screening test.