CHARACTERISTICS OF PROSTATE-CANCER DETECTED IN THE AMERICAN-CANCER-SOCIETY NATIONAL PROSTATE-CANCER DETECTION PROJECT

The American Cancer Society-National Prostate Cancer Detection Project is a prospective, comparative study of a cohort of 2,999 men 55 to 70 years old not suspected on entry of having prostate cancer. A total o f 164 prostate cancers is available from this project for analysis. A small proportion of tumors detected were advanced in terms of the clin ical stage at diagnosis. Cancer detected by digital rectal examination tended to be more advanced than that found on the basis of only trans rectal ultrasound or prostate specific antigen (PSA). A large proporti on of patients received curative therapy involving radical prostatecto my in 67.1% and radiotherapy in 18.3%. Of 103 men presumed to have org an confined disease and treated by prostatectomy 64 (37.9%) actually h ad locally extensive cancer pathologically. PSA level and PSA density were associated with the detection of organ confined cancer but severa l advanced tumors had PSA levels in the normal range. Age referenced P SA, compared to conventional standards, demonstrated lower sensitivity to cancer with little improvement in specificity. The disease resulti ng from this multimodality detection effort represented a spectrum of pathological conditions. Further followup and evaluation are needed to determine whether these benefits are reflected in long-term mortality and survival experience.