CHARACTERISTICS OF SCREENING DETECTED PROSTATE-CANCER IN MEN 50 TO 66YEARS OLD WITH 3 TO 4 NG. ML. PROSTATE-SPECIFIC ANTIGEN/

Purpose: We defined the yield and nature of prostate cancer in the set ting of population based, randomized prostate specific antigen (PSA) g uided screening in men with PSA levels between 3 and 4 ng./ml. who wer e 50 to 65 years old at the time of randomization. Materials and Metho ds: Sextant biopsies were performed in 243 men with PSA of 3 to 4 ng./ ml. Therapy decisions were based on core cancer length, histological g rade and life expectancy. Results: Of the men 32 (13.2%) had prostate cancer constituting 23% of all of the 137 prostate cancers to date det ected in the first round of our screening study. Age and PSA were simi lar in men with and without prostate cancer. Men with prostate cancer had significantly lower free PSA and free-to-total PSA ratio, and high er PSA density. Cancer was clinical stage T1c in 27 cases and stage T2 in 5. Hypoechoic areas were noted at transrectal ultrasound in 10 cas es. Digital rectal examination and transrectal ultrasound were normal in 21 cases (66%). To date 14 patients have undergone prostatectomy. S urgical specimens showed a mean tumor volume of 1.8 cc (range 0.6 to 4 .4) and significant amounts of high grade tumor were present in only 3 cases. Margins were positive in 5 cases, and pathological stage was p T2 in 8 cases and pT3 in 6. Conclusions: By lowering the PSA cutoff fr om 4 to 3 ng./ml. an increase in cancer detection by 30% was achieved. While the addition of free-to-total ratio and PSA density may reduce the number of biopsies by about 15% with sensitivity maintained at 90% , systematic sextant biopsies were necessary in most of these men as 6 6% of the tumors were negative on transrectal ultrasound and digital r ectal examination. The majority of these cancers were clinically signi ficant and suitable for curative treatment. If therapy decisions are b ased on the pathological findings of the biopsies, the risk of treatin g insignificant cancers seems low.