ECONOMICAL AND BIOMETRICAL CONSIDERATIONS IN SCREENING OF PROSTATE-CANCER

Approximately 9100 patients died of carcinoma of the prostate (CP) in West-Germany in 1988 and again in 1989. In each of these years the inc idence was estimated to be between about 30-45, i.e. between 20 000 an d 30 000 new cases in a population of about 62 million. Thus each seco nd to third patient died of his CP By comparison, early detected and o rgan-confined CP is considered curable. The survival probability of ma ny patients would therefore increase, if the point of first diagnosis could be advanced by proper screening. Alternatively, diagnosis at a l ater point in time would allow no chance of cure due to advanced stage disease. Key parameters in the evaluation of a screening program are therefore lead time, length-bias and, especially, the specifity. Assum ing that DRE and PSA are useful for screening and that TRUS and biopsy are necessary in further diagnostic workup, hypothetical total costs in Germany for 1992 can be projected. Depending on the degree of parti cipation and age groups to be included (from 40, 45 or 50 years of age to 75 years), these costs would total between a minimum of 170-250 mi llion and a maximum of 1.2-1.8 billion German marks within one year.