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| References
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Prostate-screening,
benign enlargement and cancer |
| 1.
Auvinen A, Tammela T, Stenman U-H, Uusi-Erkkila I, Leinonen
J, Schroder FH et al. Screening for prostate
cancer using serum prostate-specific antigen: A randomised,
population-based pilot study in Finland. British Journal
of Cancer Vol 74.(4.) (pp.568.-572.), 1996.
Abstract: The possibility of screening the general population
for prostate cancer using serum prostate-specific antigen
(PSA) level (alone or in combination with other tests) as
screening test has recently been discussed. A number of
studies are on the way, but the published reports have almost
exclusively been based on men volunteering for screening.
We assessed the feasibility of a screening study based on
men identified from a central population registry. A random
sample of 600 men in the age groups 55, 60 and 65 years
was identified from the Finnish Population Registry as the
study population. Half of them were randomised to tile intervention
group and an invitation to participate was sent to them.
The participation rate was 77% (230 out of 300). Twenty-five
men had a serum PSA concentration of 4.0 mug l-1 or above
and were invited for further examination including digital
rectal examination, transrectal ultrasound and transrectal
Tru-cut biopsies (directed and/or random). Six cases of
cancer were detected among the 230 participating men, which
corresponds to a detection rate of 2.6% and a positive predictive
value of 24%. The number of cases detected is equivalent
to the expected number of prostate cancer cases during a
10 year follow-up in this population. The ratio of free
to total PSA was also measured and a cut-off level of 0.20
was chosen. Its use as an additional criterion of the screening
test would have decreased the prevalence of false-positive
screening tests from 8% to 3% (7 of 230) at a cost of missing
one of the six cancers compared with serum total PSA concentration
alone. Of the six cancers, five were clinically regarded
as localised and locally confined disease was confirmed
pathologically in four of them. In conclusion, a population-based
study in Finland seems feasible and the properties of the
PSA test can be regarded as suitable for a randomised screening
study. Thus, all prerequisites for a multicentre study,
which is planned, seem to exist.
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