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Annual PSA tests are not necessary for men with a PSA level below 2 ng/mL: Findings of the Imari prostate cancer screening program
Author(s) -
Uozumi Jiro,
Tokuda Yuji,
Fujiyama Chisato,
Takagi Norito,
Meiri Hiroyuki,
Kuratomi Kazunari,
Nakamura Kouji,
Ichigi Yasuhisa,
Yoshinaga Hidetoshi,
Kinoshita Norio,
Masaki Zenjiro
Publication year - 2002
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1046/j.1442-2042.2002.00474.x
Subject(s) - medicine , prostate cancer , prostate specific antigen , urology , prostate , prostate cancer screening , cancer , gynecology
Background: Annual changes in prostate specific antigen (PSA) levels detected by the Imari prostate cancer screening program were evaluated to establish a more efficient and cost‐saving screening system, especially for men with low PSA levels. Methods: Prostate specific antigen‐based annual mass screenings for prostate cancer were conducted for men aged 60–69 in the Imari district, Saga, Japan. Between 1992 and 2000, 1822 men had their PSA levels tested. A total of 4661 PSA tests were conducted. Changes in PSA levels over the following 1 to 5 years were analyzed in men with PSA levels of 3 ng/mL or less, a range in which the detection rate of prostate cancer would seem to be negligibly low. Results: The overall detection rate of prostate cancer between 1992 and 2000 was 0.73%. The detection rate in men with a PSA level between 3.1 and 3.9 ng/mL, and between 4 and 9.9 ng/mL was 1.6% and 8.3%, respectively. Of 4661 determinations of PSA, 2553 (54.8%) were found to be ≤ 1 ng/mL, 1273 (27.3%) were between 1.1 and 2 ng/mL, and 401 (8.6%) were between 2.1 and 3 ng/mL. Four hundred and thirty‐four men (9.3%) had PSA levels ≥ 3.1 ng/mL, with possible indications for prostate biopsy. Of the men tested, 1.4% with an initial PSA level of ≤ 2 ng/mL and 22.3% with an initial level between 2.1 and 3 ng/mL had a PSA level of ≥ 3.1 ng/mL after 1 year. Almost the same rate of PSA increase was observed between the two PSA tests conducted at 2 to 5‐year intervals. Of the men tested, 2.2% with an initial PSA level of ≤ 2 ng/mL, and 21.9% with an initial level between 2.1 and 3 ng/mL, had a level of ≥ 3.1 ng/mL after 5 years. Conclusion: Levels of PSA in men with an initial level below 2 ng/mL remained stable for up to 5 years. Levels of PSA in 97.8– 98.8% of men remained below 3 ng/mL after 1 to 5 years. In contrast, 18–35.3% of men with an initial PSA level between 2.1 and 3 ng/mL showed PSA progression to 3.1 ng/mL or more within 5 years. Our present data suggest that annual PSA testing is not necessary for men with a PSA level below 2 ng/mL. Prostate specific antigen testing could therefore be conducted at longer intervals in such individuals.