TY - JOUR
T1 - Serum prostate-specific antigen and digital rectal examination for early detection of prostate cancer in a national community-based program
AU - Crawford, E. David
AU - DeAntoni, Edward P.
AU - Etzioni, Ruth
AU - Schaefer, Virginia C.
AU - Olson, Robert M.
AU - Ross, Colleen A.
N1 - Funding Information:
*This studv was funded in part by an unrestricted educational grant from Abbok Diagnos&s, Abbott Park, Ill. IMx is a registered trademark of Abbott Laboratories. ‘See appendix for list of investigators. From the Division of Urology, University of Colorado Health Sciences Center, Denver, Colorado; Biostatistics Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; and Abbott Diagnostics, Abbott Laboratories, Abbott Park, Illinois Reprint requests: Edward DeAntoni, Ph.D., Assistant Professor, Division of Urology, University of Colorado Health Sciences Center, Campus Box C319, 4200 East Ninth Avenue, Denver, CO 80262 Submitted (Rapid Communication): November 7, 1995, accepted (with revisions): February 19, 1996
PY - 1996/6
Y1 - 1996/6
N2 - Objectives. This study analyzed methods of prostate cancer early detection in community settings throughout the United States against standards and findings of earlier studies conducted at academic medical centers. Methods. The study was conducted at 148 clinical centers during Prostate Cancer Awareness Week in September 1993 and continued through June 1994. A total of 31,953 eligible subjects were tested by both digital rectal examination (DRE) and prostate-specific antigen (PSA). PSA was tested with the Abbott IMx PSA assay and reported by Roche Biomedical, Inc. Results. The study confirmed that elevated PSA levels (greater than 4.0 ng/mL) aid in the detection of organ-confined prostate cancer when used in conjunction with the DRE. Reflecting more conservative biopsy decision-making practices, study results nonetheless are comparable to earlier reports. Among 1307 subjects who underwent biopsy, 322 cancers were detected. The cancer detection rate was 3.6% for PSA, 3.0% for DRE, and 4.7% if either test result was positive. The positive predictive value (PPV) for elevated PSA levels (greater than 4.0 ng/mL) was 31.6%, significantly better (P <0.0001) than the PPV for abnormal DRE results (25.5%). Nearly 90% (88.9%) of staged cancers were diagnosed as localized. Elevated PSA levels detected more localized cancers (76 of 105 [72.4%]) than the DRE (72 of 105 [68.6%]). Of localized tumors, 33 (31.4%) were missed by DRE and detected solely by PSA, and 29 (27.6%) were missed by PSA and detected solely by DRE. The combined use of the two methods detected 33 additional localized tumors. Conclusions. Community practice throughout the United States demonstrates that PSA and DRE are consistently effective and efficient in the early detection of prostate cancer.
AB - Objectives. This study analyzed methods of prostate cancer early detection in community settings throughout the United States against standards and findings of earlier studies conducted at academic medical centers. Methods. The study was conducted at 148 clinical centers during Prostate Cancer Awareness Week in September 1993 and continued through June 1994. A total of 31,953 eligible subjects were tested by both digital rectal examination (DRE) and prostate-specific antigen (PSA). PSA was tested with the Abbott IMx PSA assay and reported by Roche Biomedical, Inc. Results. The study confirmed that elevated PSA levels (greater than 4.0 ng/mL) aid in the detection of organ-confined prostate cancer when used in conjunction with the DRE. Reflecting more conservative biopsy decision-making practices, study results nonetheless are comparable to earlier reports. Among 1307 subjects who underwent biopsy, 322 cancers were detected. The cancer detection rate was 3.6% for PSA, 3.0% for DRE, and 4.7% if either test result was positive. The positive predictive value (PPV) for elevated PSA levels (greater than 4.0 ng/mL) was 31.6%, significantly better (P <0.0001) than the PPV for abnormal DRE results (25.5%). Nearly 90% (88.9%) of staged cancers were diagnosed as localized. Elevated PSA levels detected more localized cancers (76 of 105 [72.4%]) than the DRE (72 of 105 [68.6%]). Of localized tumors, 33 (31.4%) were missed by DRE and detected solely by PSA, and 29 (27.6%) were missed by PSA and detected solely by DRE. The combined use of the two methods detected 33 additional localized tumors. Conclusions. Community practice throughout the United States demonstrates that PSA and DRE are consistently effective and efficient in the early detection of prostate cancer.
UR - http://www.scopus.com/inward/record.url?scp=0029971101&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0029971101&partnerID=8YFLogxK
U2 - 10.1016/S0090-4295(96)00061-1
DO - 10.1016/S0090-4295(96)00061-1
M3 - Article
C2 - 8677578
AN - SCOPUS:0029971101
SN - 0090-4295
VL - 47
SP - 863
EP - 869
JO - Urology
JF - Urology
IS - 6
ER -