SCREENING FOR PROSTATE-CANCER BY DIGITAL RECTAL EXAMINATION AND PROSTATE-SPECIFIC ANTIGEN - RESULTS OF PROSTATE-CANCER AWARENESS WEEK, 1989-1992

Objective. To evaluate the use of digital rectal examination (DRE), prostate specific antigen (PSA), and age-specific reference values for PSA when screening for prostate cancer in a national screening program. Methods. Data collected during Prostate Cancer Awareness Week (PCAW), 1989-1992, were used for comparing DRE and PSA. Results. More than 1,000,000 men were screened at 4141 sites from 1989-1992. The rate of abnormal DRE for all 4 years was 13.1%, and the rate of elevated PSA (> 4.0 ng/mL) was 14.4% for the same period. PSA proved superior to DRE in sensitivity, positive predictive value, and accuracy in making a cancer diagnosis. Screening resulted in 77.7% of diagnosed cases being determined as clinically localized disease. Age-specific PSA reference values added a slight improvement in sensitivity at lower ages and an improvement in positive predictive value in older men. Conclusions. Data from PCAW establish the success of national prostate cancer screening and suggest that further refinements with age-specific PSA reference values may improve overall results.