SCREENING FOR CARCINOMA OF THE PROSTATE - A GP BASED STUDY

Objective To examine the feasibility and acceptability of screening fo r cancer of the prostate by digital rectal examination (DRE), prostate specific antigen (PSA) determination and subsequent transrectal ultra sound (TRUS) in selected patients in a single general practice in Hert fordshire. Subjects and methods A total of 568 of 856 men aged 55 to 7 0 accepted an invitation for a health check which included screening f or prostate cancer. Of these, 80 individuals with either a raised PSA level or an abnormal DRE underwent TRUS. In 29 individuals biopsies we re taken, 11 of which confirmed the presence of adenocarcinoma of the prostate giving an overall detected prevalence of 2%. Of the 11 tumour s identified by screening, two were T(1)M(0), four were T(2)M(0), two were T(3)M(0) and three were T(3)M(1). Results To assess the acceptabi lity of the screening exercise a postal questionnaire was sent to all 568 participants: 83% replied and 69% reported no concern. Of the 67 i ndividuals who had undergone TRUS, 69% reported discomfort. A total of 448 (95%) of respondents declared that they would be prepared to unde rgo the screening exercise again. Conclusion Screening for prostate ca ncer would seem to be technically feasible and generally acceptable. H owever, there is a considerable false positive rate in the PSA range 4 ng/ml to 10ng/ml, particularly among men with clinical evidence of ben ign prostatic hyperplasia. To establish the true benefit of screening a large-scale prospective controlled study will be necessary.