The American cancer society national prostate cancer detection project. Findings on the detection of early prostate cancer in 2425 men

Abstract

The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) is a multidisciplinary, multicenter effort to assess the feasibility of early prostate cancer detection by digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA) assay. By June 1990, 2425 men not previously suspected of having prostate cancer had been examined in ten participating clinical centers according to the project protocol. Three hundred ninety-six men (16.3%) were recommended for biopsy on the basis of TRUS or DRE. An analysis of the results of 330 completed biopsies showed 52 cancers detected by DRE and/or TRUS. Forty-four (84.6%) of the men with cancer had positive TRUS examination results compared with 33 (63.5%) with positive DRE. Five additional cancers were discovered as a result of elevated PSA levels. The overall detection rate was 2.4% and this rate varied by age. The detection rate in men 55 to 60 years of age was 1.3% and this rose to 3.3% in men older than 65 years of age. The estimated sensitivity was significantly greater for TRUS compared with DRE (77.2% versus 57.9%; P less than 0.05). The estimated specificity of DRE was greater than that of TRUS (96.3% versus 89.4%; P less than 0.01). The positive predictive value (PPV) for the tests varied as a function of patient and disease characteristics. The overall PPV was 28.0% for DRE and 15.2% for TRUS. The occurrence of elevated PSA levels significantly increased the PPV of both TRUS and DRE. The majority of cancers detected were at early stages. These preliminary data suggest the feasibility of using these techniques to promote cancer control, but additional data and follow-up are needed to assess the significance of the results.

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

“…12 The prostatic carcinoma discovery rate in Japan, when we changed to mass screening that used PSA as the only tumor marker was 2.31% of the subjects that were examined in a mass screening for the first time. 13 If age adjustment was made, this discovery rate was not different from the incidence of 1.5-4.1% in the U.S. [1][2][3]14 The prostate carcinoma discovery rate in Japan was not different from that in the U.S. when we performed a systematic screening study. Epidemiologic studies predict that the death rate from prostatic carcinoma will increase by approximately threefold by 2015 in Japan compared with the current rate.…”

“…[1][2][3] The information on the future incidence of prostate carcinoma and the follow-up methods of those cases is very important. Three studies have reported longitudinal changes in serum PSA levels in men with initial PSA levels of 4.0 ng/mL or less.…”

The role of magnetic resonance imaging (MRI) in prostate cancer imaging and staging at 1.5 and 3 Tesla: The Beth Israel Deaconess Medical Center (BIDMC) approach

“…However, many cancers are undetectable and are presumably isoechoic. In the American Cancer Society prostate screening study of 2427 men, a total of 52 cancers were detected [28]. Of these, TRUS detected 44 (85%), indicating its limited sensitivity.…”

Increased oncogenic microRNA-18a expression in the peripheral blood of patients with prostate cancer: A potential novel non-invasive biomarker

“…The mechanisms underlying the occurrence and progression of the disease remain largely unknown. Generally, patients with PC do not exhibit symptoms until the disease becomes locally advanced or metastatic (2). Prostate-specific antigen (PSA) detection in serum is the current standard diagnostic tool for PC.…”