Mass screening for prostate carcinoma: a study in Hokkaido, Japan

Decline in Prostate Cancer Screening by Primary Care Physicians: An Analysis of Trends in the Use of Digital Rectal Examination and Prostate Specific Antigen Testing

PURPOSE

Prostate cancer screening by digital rectal examination and prostate specific antigen testing has been routine clinical practice in the United States for the last 25 years. Recent studies have shown a national decline in prostate specific antigen testing following the USPSTF (United States Preventive Services Task Force) recommendation against routine prostate specific antigen screening. However, to our knowledge the effect of this recommendation on digital rectal examination utilization remains unknown.

MATERIALS AND METHODS

We used NAMCS (National Ambulatory Medical Care Survey) to characterize trends in the rate of digital rectal examination and prostate specific antigen testing by primary care physicians in men older than 40 years presenting for preventive care. From 2005 to 2012 NAMCS contained 3,368 such visits (unweighted) for the study of digital rectal examination trends and 4,035 unweighted visits from 2002 to 2012 for the study of prostate specific antigen trends.

RESULTS

Following the USPSTF recommendation the proportion of visits where digital rectal examination was performed decreased from 16.0% (95% CI 13.1-19.5) to 5.8% (95% CI 4.0-8.3, p <0.001). Similarly, the proportion of visits where prostate specific antigen testing was performed decreased from 27.3% (95% CI 24.5-30.3) to 16.7% (95% CI 12.9-21.2, p <0.001). This represents a relative 64% decrease in digital rectal examination and a 39% decrease in prostate specific antigen testing. Among men 55 to 69 years old the number of visits where digital rectal examination and prostate specific antigen testing were performed decreased 65% and 39%, respectively (p <0.001).

CONCLUSIONS

Utilization of digital rectal examination and prostate specific antigen has declined significantly following the release of the USPSTF recommendation against prostate specific antigen screening. This suggests that prostate cancer screening is rapidly disappearing from primary care practice.

Mass screening for prostate cancer in patients with end-stage renal disease: a comparative study

OBJECTIVE

To determine the usefulness of prostate-specific antigen (PSA) screening for prostate cancer in patients with end-stage renal disease (ESRD), as although serum PSA is effective in the early detection of this cancer in the general population, there are few reports of its utility in patients with ESRD.

PATIENTS AND METHODS

Blood samples were obtained for PSA screening from April 2002 to September 2003; 1250 men with ESRD aged >50 years were compared with 1007 healthy control men aged >55 years, all in Kumamoto Prefecture, Japan. All men with a serum PSA level of >4.0 ng/mL were categorized as PSA-positive and were further assessed, including a prostate biopsy.

RESULTS

There was a statistically significantly greater increase in PSA level with age in the ESRD group than in the healthy controls. The rate of cancer detection among men with a PSA level of >10 ng/mL was significantly higher in patients with ESRD than in healthy controls. Thirteen patients with ESRD and five healthy control men were finally diagnosed with prostate cancer.

CONCLUSION

The serum PSA level was slightly higher and the incidence of prostate cancer at higher PSA levels appeared to be greater in men with ESRD than in healthy controls. The findings of this large study suggest that PSA screening is useful for the diagnosis of prostate cancer in these patients.

[Screening for prostate cancer: arguments "in favour"]

Prostate cancer is a problem of public health; the relevance of its mass screening remains to be demonstrated by the conclusions of ongoing randomized prospective studies of which the preliminary results are promising. Yet, non-randomised and/or retrospective studies report a benefit of screening-related mortality. On such basis, French scientific authorities currently recommend individual screening.

Mass screening of prostate cancer in Changchun City of China

OBJECTIVES

Mass screening of prostate cancer in China had not been studied until now. To clarify the incidence of prostate cancer among the population of aged men in Changchun City of China, we performed a mass screening program for prostate cancer using prostate specific antigen (PSA).

METHODS

Men aged more than 50 years were examined by PSA, with a cut-off values 4.1 ng/ml. Subjects, whose serum PSA concentration was more than 4.1 ng/ml, were recommended to secondary examination of transrectal ultrasound-guided systematic six-sextant biopsy examination (TRUS-guided biopsy).

RESULTS

Between April 1998 and December 2000, in the urban area of Changchun City 4218 men over 50 years old were screened. As 190 men were found to have elevated PSA and 116 men underwent a TRUS-guided biopsy of the prostate, of whom 29 men were found to have cancer. In all, the age-adjusted PSA positive rate was 4.80%, cancer detection rate was 0.74%. The age-adjusted cancer detection rate was 0.78%. After adjusted for secondary examination rate, the cancer detection rate reached 1.28%. The cases of stage B with limited cancer within the prostate gland, accounted for 62% of 29 cancer cases. Stage B was much more detected (accounted for 60%) in the PSA range of 4.1-10.0 ng/ml. Stage C and D were much more detected (accounted for 85.71%) in the PSA range over 10.1 ng/ml, with a significant difference by Fisher exact test (P < 0.05). A significant correlation of age-adjusted PSA positive rate and age-adjusted cancer detection rate adjusted by secondary examination rate was showed in six groups of Community and Army, Factory, Corporation, Post and Telecom Office, Government and Academy, and University and Technical School (r = 0.898, P < 0.01). Both of the age-adjusted PSA positive rate and age-adjusted cancer detect rate of "Universities and Technical Schools" were significantly higher than that of "Factories" (chi2 test P < 0.05).

CONCLUSIONS

The prevalence of prostate cancer was not so low in Chinese people as expected. For 50 years or older men, cancer detection rate was 0.74%, The age-adjusted cancer detect rate was 0.78%. Much more early stage cancer could be detected in the screening using serum PSA. For the different company the detection rate of prostate cancer varied each other among the groups. Age-adjusted cancer detection rate in "Universities and Technical Schools" were significantly higher than in "Factories", suggesting environment factor or diet might be associated with the prostate cancer.

Detection of prostate cancer by prostate-specific antigen

The use of prostate-specific antigen (PSA) for early detection of prostate cancer has dramatically increased the reported incidence of this malignancy but its net benefit is unclear and remains controversial at present. Although several countries have adopted prostate cancer screening as a health policy, a reduction of cancer mortality would be an ultimate indication of the effectiveness of early detection. Since screening upon patient request cannot be refused, appropriate information should be provided until further support is available.

Diagnostic strategies for the early detection of prostatic cancer

— We carried out an investigational study of early detection of prostate carcinoma, using digital rectal examination (DRE) and serum prostate specific antigen (PSA). We determined the detection rate and some profiles of the carcinoma detected by screening in men from 50 to 80 years old. The detection rate was 2.3% in 1345 participants. In 20 men (64.5%) the disease was T1c or T2 and in 16 patients we performed radical prostatectomy.