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Population‐based screening for prostate cancer by measuring total serum prostate‐specific antigen in Iran
Author(s) -
Hosseini Seyyed Yousof,
Moharramzadeh Massood,
Ghadian Ali Reza,
Hooshyar Hassan,
Lashay Ali Reza,
Safarinejad Mohammah Reza
Publication year - 2007
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 - 10.1111/j.1442-2042.2006.01729.x
Subject(s) - medicine , rectal examination , transrectal ultrasonography , prostate cancer , urology , prostate , prostate specific antigen , biopsy , prostate biopsy , population , cancer , gynecology , prostate cancer screening , environmental health
Objective: To report the results from an Iranian large population‐based randomized study of screening using prostate‐specific antigen (PSA) to detect prostate cancer. Materials and Methods: A total of 3758 Iranian men older than 40 years were mass checked by PSA‐based screening. Men with an abnormal digital rectal examination (DRE) and serum total PSA level of greater than 4 ng/mL, underwent transrectal ultrasonography (TRUS)‐guided extended prostate biopsy. Results: The PSA value (mean ± standard deviation, SD) in all men without prostate cancer was 1.6 ± 1.1 ng/mL and in those with cancer 18 ± 44.8 ng/mL ( P = 0.001). PSA values increased with age. In those aged 40–49, 50–59, 60–69 and ≥70 years, the mean ± SD PSA values were 1.3 ± 0.7, 1.4 ± 0.8, 1.8 ± 1 and 2.2 ± 1.6 ng/mL, respectively. Among the screened men, 323 (8.6%) had a serum PSA concentration greater than 4 ng/mL. Of patients who underwent prostate biopsy (230, 71.2%), 129 (positive predictive value, 56.1%) had prostate cancer. Additionally, nine cancers were detected among 16 patients with PSA of less than 4 ng/mL who had a doubtful DRE finding. The overall cancer detection rate was 3.6%; 1.4% at 40–49, 1.6% at 50–59, 4.2% at 60–69 and 12.9% at ≥70 years. Conventional systematic sextant biopsies, which accounted for six of the 10 cores in our biopsy scheme, detected 98 (71%) of the cancers. Conclusions: The Iranian male population develops prostate cancer quite commonly if their serum PSA levels are greater than 4.0 ng/mL. In this study, 65.9% of the detected cancers were clinically significant. The conventional systematic sextant technique may be inappropriate for detection of all prostate cancers. The results need to be confirmed in other randomized trials.