Prostate-specific antigen as a screening test - The Netherlands experience

At the Rotterdam site of the European Randomized Study of Screening for Prostate Carcinomas about 9600 men between 54 and 76 years old have been randomized, of which 50% for screening by prostate-specific antigen (PSA), digital rectal examination (DRE), and transrectal ultrasonography up to March 1996. The detection rate of cancer is 4.3%, and the overall number of biopsies per cancer is 5.1. By clinical staging 91% of cancers are organ-confined (T2c or less); by pathologic staging after radical prostatectomy 56% are confined. The best sole predictor of a positive biopsy is total serum PSA, followed by DRE. In the intermediate PSA range between 4 and 10 ng/mL the free to total PSA ratio of 0.20 can reduce significantly the number of false-positive biopsy indications by 38% at a loss of 12% of undetected carcinomas.