Long term follow-up of mass screening for prostate carcinoma in men with initial prostate specific antigen levels of 4.0 ng/mL or less

BACKGROUND. Long term follow-up for subjects whose initial prostate specifi c antigen (PSA) levels were 4.0 ng/mL or lower was conducted to investigate the proper interval for PSA screening. METHODS. Eight thousand five hundred ninety-five men aged 50 years or older with an initial PSA level of 4.0 ng/mL or lower were screened with tumor m arker measurement and/or digital rectal examination (DRE) and/or transrecta l ultrasonography as a first step in the mass screening, and a prostate bio psy was performed for individuals with abnormal findings. RESULTS, Cancer was detected in 0.18% (8 of 4526), 1.0% (27 of 2724), and 3 .6% (49 of 1345) of men whose initial PSA levels were lower than 1.0, 1.0-1 .9, and 2.0-4.0 ng/mL, respectively. Among these prostate carcinoma cases, 25% (6 of 81, 56% (15 of 27), and 63% (31 of 49) were detected by abnormal PSA in patients With initial PSA levels lower than 1.0, 1.0-1.9, and 2.0-4. 0 ng/mL, respectively. The detection rates of prostate carcinoma within 3 y ears after the initial visit were 0.07%, 0.24%, and 1.2% in cases with init ial PSA levels lower than 1.0, 1.0-1.9, and 2.0-4.0 ng/mL, respectively. CONCLUSIONS. It is recommended that DRE and PSA measurements should be perf ormed once every 3 years in individuals with initial PSA levels of less tha n 1.0 ng/mL. The prostate carcinoma detection rate increased over time in i ndividuals with initial PSA levels of 1.0 to 4.0 ng/mL, especially in cases with 2.0-4.0 ng/mL, and annual measurement of PSA was more useful than DRE . Therefore, it is recommended that PSA screening should be performed once every year for individuals with initial PSA levels of 1.0 to 4.0 ng/mL. (C) 2001 American Cancer Society.