Final results of a screening campaign for prostate cancer.

Abstract

To detect curable prostate cancer in a male Spanish population. The results of screening 2,576 men are reported. Patients underwent digital rectal examination (DRE) and serum prostate-specific antigen (PSA) determination. Any patient with suspicious DRE or PSA > 4 ng/ml was further evaluated with transrectal ultrasonography (TRUS) and biopsy. The sensitivity, specificity and predictive value of the tests or combinations of tests were determined. Mean age was 59.9 years (median 58 years). Ninety-four patients (3.6%) had abnormal DRE while PSA was > 4 ng/ml in 169 patients (6.5% of the total). We needed 6.8 biopsies to prove one cancer. PSA had the highest sensitivity (93%), whereas DRE had the highest specificity (97%). The positive predictive value rose to 78.9% when both DRE and PSA were abnormal. Clinically advanced tumor stages (> or = T3) were commoner (39.4%) than in similar series. PSA should be the first diagnostic test in a screening program for prostate cancer. Neither DRE nor TRUS are necessary in patients with PSA < 4 ng/ml. In the light of our findings, we cannot encourage screening programs for prostate cancer for the time being.