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. 1996 Aug;74(4):568–572. doi: 10.1038/bjc.1996.402

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

A Auvinen 1, T Tammela 1, U H Stenman 1, I Uusi-Erkkilä 1, J Leinonen 1, F H Schröder 1, M Hakama 1
PMCID: PMC2074672  PMID: 8761371

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 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 micrograms 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% (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.

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Selected References

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  1. Brawer M. K., Chetner M. P., Beatie J., Buchner D. M., Vessella R. L., Lange P. H. Screening for prostatic carcinoma with prostate specific antigen. J Urol. 1992 Mar;147(3 Pt 2):841–845. doi: 10.1016/s0022-5347(17)37401-3. [DOI] [PubMed] [Google Scholar]
  2. Carter H. B., Pearson J. D., Metter E. J., Brant L. J., Chan D. W., Andres R., Fozard J. L., Walsh P. C. Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA. 1992 Apr 22;267(16):2215–2220. [PMC free article] [PubMed] [Google Scholar]
  3. Catalona W. J., Richie J. P., deKernion J. B., Ahmann F. R., Ratliff T. L., Dalkin B. L., Kavoussi L. R., MacFarlane M. T., Southwick P. C. Comparison of prostate specific antigen concentration versus prostate specific antigen density in the early detection of prostate cancer: receiver operating characteristic curves. J Urol. 1994 Dec;152(6 Pt 1):2031–2036. doi: 10.1016/s0022-5347(17)32299-1. [DOI] [PubMed] [Google Scholar]
  4. Catalona W. J., Smith D. S., Ratliff T. L., Basler J. W. Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening. JAMA. 1993 Aug 25;270(8):948–954. [PubMed] [Google Scholar]
  5. Chadwick D. J., Kemple T., Astley J. P., MacIver A. G., Gillatt D. A., Abrams P., Gingell J. C. Pilot study of screening for prostate cancer in general practice. Lancet. 1991 Sep 7;338(8767):613–616. doi: 10.1016/0140-6736(91)90615-v. [DOI] [PubMed] [Google Scholar]
  6. Gann P. H., Hennekens C. H., Stampfer M. J. A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. JAMA. 1995 Jan 25;273(4):289–294. [PubMed] [Google Scholar]
  7. Hakama M., Elovainio L., Kajantie R., Louhivuori K. Breast cancer screening as public health policy in Finland. Br J Cancer. 1991 Nov;64(5):962–964. doi: 10.1038/bjc.1991.436. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hakama M., Räsänen-Virtanen U. Effect of a mass screening program on the risk of cervical cancer. Am J Epidemiol. 1976 May;103(5):512–517. doi: 10.1093/oxfordjournals.aje.a112253. [DOI] [PubMed] [Google Scholar]
  9. Helzlsouer K. J., Newby J., Comstock G. W. Prostate-specific antigen levels and subsequent prostate cancer: potential for screening. Cancer Epidemiol Biomarkers Prev. 1992 Nov-Dec;1(7):537–540. [PubMed] [Google Scholar]
  10. Labrie F., Dupont A., Suburu R., Cusan L., Tremblay M., Gomez J. L., Emond J. Serum prostate specific antigen as pre-screening test for prostate cancer. J Urol. 1992 Mar;147(3 Pt 2):846–852. doi: 10.1016/s0022-5347(17)37402-5. [DOI] [PubMed] [Google Scholar]
  11. Leinonen J., Zhang W. M., Stenman U. H. Complex formation between PSA isoenzymes and protease inhibitors. J Urol. 1996 Mar;155(3):1099–1103. [PubMed] [Google Scholar]
  12. Mettlin C., Littrup P. J., Kane R. A., Murphy G. P., Lee F., Chesley A., Badalament R., Mostofi F. K. Relative sensitivity and specificity of serum prostate specific antigen (PSA) level compared with age-referenced PSA, PSA density, and PSA change. Data from the American Cancer Society National Prostate Cancer Detection Project. Cancer. 1994 Sep 1;74(5):1615–1620. doi: 10.1002/1097-0142(19940901)74:5<1615::aid-cncr2820740520>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  13. Mettlin C., Murphy G. P., Lee F., Littrup P. J., Chesley A., Babaian R., Badalament R., Kane R. A., Mostofi F. K. Characteristics of prostate cancers detected in a multimodality early detection program. The Investigators of the American Cancer Society-National Prostate Cancer Detection Project. Cancer. 1993 Sep 1;72(5):1701–1708. doi: 10.1002/1097-0142(19930901)72:5<1701::aid-cncr2820720534>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  14. Paus E., Theodorsen L., Engeland A. Prostate-specific antigen in serum from blood donors with subsequent prostate cancer diagnosis. Eur J Cancer. 1993;29A(8):1221–1222. doi: 10.1016/s0959-8049(05)80333-8. [DOI] [PubMed] [Google Scholar]
  15. Schröder F. H., Denis L. J., Kirkels W., de Koning H. J., Standaert B. European randomized study of screening for prostate cancer. Progress report of Antwerp and Rotterdam pilot studies. Cancer. 1995 Jul 1;76(1):129–134. doi: 10.1002/1097-0142(19950701)76:1<129::aid-cncr2820760120>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  16. Stenman U. H., Hakama M., Knekt P., Aromaa A., Teppo L., Leinonen J. Serum concentrations of prostate specific antigen and its complex with alpha 1-antichymotrypsin before diagnosis of prostate cancer. Lancet. 1994 Dec 10;344(8937):1594–1598. doi: 10.1016/s0140-6736(94)90405-7. [DOI] [PubMed] [Google Scholar]
  17. Teppo L., Pukkala E., Lehtonen M. Data quality and quality control of a population-based cancer registry. Experience in Finland. Acta Oncol. 1994;33(4):365–369. doi: 10.3109/02841869409098430. [DOI] [PubMed] [Google Scholar]
  18. Walsh P. C., Partin A. W., Epstein J. I. Cancer control and quality of life following anatomical radical retropubic prostatectomy: results at 10 years. J Urol. 1994 Nov;152(5 Pt 2):1831–1836. doi: 10.1016/s0022-5347(17)32396-0. [DOI] [PubMed] [Google Scholar]
  19. Whittemore A. S., Lele C., Friedman G. D., Stamey T., Vogelman J. H., Orentreich N. Prostate-specific antigen as predictor of prostate cancer in black men and white men. J Natl Cancer Inst. 1995 Mar 1;87(5):354–360. doi: 10.1093/jnci/87.5.354. [DOI] [PubMed] [Google Scholar]
  20. Zagars G. K., Pollack A., Kavadi V. S., von Eschenbach A. C. Prostate-specific antigen and radiation therapy for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 1995 May 15;32(2):293–306. doi: 10.1016/0360-3016(95)00077-C. [DOI] [PubMed] [Google Scholar]

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