Screening for prostate cancer using serum prostate-specific antigen: a randomised, population-based pilot study in Finland

Abstract

Summary 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 the 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 pg I-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 falsepositive screening tests from 8% (19 of 230) 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.

Mass screening of prostate cancer in Changchun City of China

“…Screening and early detection thus can identify many of the silent tumors (stage A1, usually asymptomatic) in the population. Screening program in western countries detect prostate cancer in 2.0-4.8% of those screened [9][10][11][12][13][14][15][16][17][18], but the rate is only 1.1-1.3% in Japanese men [19][20][21]. We found that PSA increased the detection rate of early stage of prostate cancer.…”

The story of the European Randomized Study of Screening for Prostate Cancer

“…Finland became the third partner to enter the ERSPC [7]. A summary of the first three pilot studies is presented in Table 1[8–10].…”

“…Grant applications were successful in Belgium and the Netherlands, and the European Union was ready to continue financing the international co‐ordination. The ERSPC started on 1 July 1994, and Finland joined a year later after successfully conducting a pilot study [7].…”

Prostate-Specific Antigen and Early Detection of Prostate Cancer

“…Although most prostate tumors are slow growing and do not cause serious mortality, some are fast growing and may metastasize rapidly and widely to other organs especially to the bone. The silen 'latent' cancers that are unlikely to progress to cause significant mor bidity and mortality are found at autopsy or incidentally and represent 80% of the early prostate cancers, whereas the other 20% are 'clinical' cancers that are likely to progress to cause disease and are potentially lethal and life-threatening [32][33][34], Thirty percent of men older than 50 years of age harbor one form or the other, i.e., 6% prevalence rate of 'clinical' cancer [32], As shown in table 3, PSA-based screening tests have been performed during the past sev eral years in various regions of the world [23,24,[31][32][33][34][35][36][37][38][39][40][41], Prostate cancer detection rates range from 1 % in Japan to 4.8% in the US and appear to be proportional to incidence rate in these countries. Of interest to note are the findings of the trials where both clinical and pathological stagings are detailed [23,33,34,36,39].…”