COMPARING 2 MODALITIES OF SCREENING FOR PROSTATE-CANCER - DIGITAL RECTAL EXAMINATION PLUS TRANSRECTAL ULTRASONOGRAPHY VS PROSTATE-SPECIFIC ANTIGEN

Aims and background: To evaluate the performance and feasibility of sc reening for prostate cancer by comparing screening modalities. Methods : Prospective study of two comparable cohorts of healthy resident male s aged 60 to 75 years. Screening attenders in the two invited cohorts were screened either by digital rectal examination (DRE) and transrect al ultrasonography (TRUS), or by serum prostate-specific antigen deter mination (PSA: cutoff 4 ng/ml). Attendance and biopsy rates, predictiv e values, prevalence of screen-detected cancers, as well as screening costs were determined, and the efficiency of the two screening modalit ies was compared. Results: 1425 subjects were screened by DRE + TRUS. Attendance rate was 33.7%, the biopsy rate was 2.7%, and the prevalenc e of detected cancers was 1.82%. A total of 1315 subjects was screened by PSA. Attendance rate was 66.9%, the biopsy rate was 2.8%, and the prevalence of detected cancers was 1.67%. Screen-detected cancer stage was more favorable than observed in clinical practice, and early dete ction was evident, with the prevalence/incidence ratio higher than 10: 1 in both programs. The cost per subject screened was about 34,000 Lir e for DRE + TRSU and about 30,000 Lire for PSA program. Conclusions: T he study confirms that early detection of prostate cancer is possible and that screening is practically feasible. Both screening modalities achieved comparable results as regards early detection, but screening by PSA had a higher compliance and lower costs. PSA seems the ideal te st to be used in prospective controlled studies aimed at demonstrating screening efficacy.