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Population-based screening for prostate cancer by measuring free and total serum prostate-specific antigen in Sweden

Hugosson, J; Aus, G; Bergdahl, S; Fernlund, Per LU ; Frosing, R; Lodding, P; Pihl, C G and Lilja, Hans LU (2003) In BJU International1999-01-01+01:00 92. p.39-43
Abstract
Objectives To report the initial results from Sweden of a large population-based randomized study of screening using prostate-specific antigen (PSA) to detect prostate cancer, as the efficacy of such screening to decrease prostate cancer mortality has not yet been proven. Methods From the population registry men aged 50-66 years were randomized to screening (9973) and to future controls (9973). Men randomized to screening were invited to have their serum measured for free PSA (fPSA) and total PSA (tPSA) in serum using the Prostatus(R) f/tPSA assay (Perkin-Elmer, Turku, Finland). Men with a tPSA of <3.0 ng/mL were not further investigated, while those with a tPSA of &GE;3.0 ng/mL were investigated with a digital rectal examination... (More)
Objectives To report the initial results from Sweden of a large population-based randomized study of screening using prostate-specific antigen (PSA) to detect prostate cancer, as the efficacy of such screening to decrease prostate cancer mortality has not yet been proven. Methods From the population registry men aged 50-66 years were randomized to screening (9973) and to future controls (9973). Men randomized to screening were invited to have their serum measured for free PSA (fPSA) and total PSA (tPSA) in serum using the Prostatus(R) f/tPSA assay (Perkin-Elmer, Turku, Finland). Men with a tPSA of <3.0 ng/mL were not further investigated, while those with a tPSA of &GE;3.0 ng/mL were investigated with a digital rectal examination (DRE), transrectal ultrasonography (TRUS) and sextant biopsies. Results Of those invited, 60% accepted PSA testing and 11.3% had a tPSA of &GE;3.0 ng/mL. Altogether 145 cancers were detected (positive predictive value, PPV, 24%); none were stage M1, two were stage N+ and 10 stage T3-4. Most (59%) cancers were impalpable and 39% were both impalpable and invisible on TRUS. At biopsy, 7% were Gleason score 2-4, 71% 5-6, 19% 7 and 2% Gleason score 8-10. A threshold tPSA of &GE;4.0 ng/mL would have detected 109 cancers in 366 biopsied men (PPV 30%) while cancer detection would have been 14% higher with a PPV of 36% using a threshold tPSA of &GE;3.0 ng/mL combined with a f/tPSA threshold of &LE;18%. Conclusion PSA screening detects early-stage low-grade prostate cancer. Both the sensitivity and specificity can be increased by incorporating f/tPSA with a tPSA threshold of <4 ng/mL. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
early detection, PSA, prostate cancer, epidemiology
in
BJU International1999-01-01+01:00
volume
92
pages
39 - 43
publisher
Blackwell Science Ltd
external identifiers
  • wos:000187880900008
  • scopus:0346496002
ISSN
1464-4096
DOI
language
English
LU publication?
yes
id
16272af8-0504-4644-b093-a426ee2d3ee4 (old id 291157)
date added to LUP
2007-09-13 12:10:57
date last changed
2018-05-29 11:01:36
@article{16272af8-0504-4644-b093-a426ee2d3ee4,
  abstract     = {Objectives To report the initial results from Sweden of a large population-based randomized study of screening using prostate-specific antigen (PSA) to detect prostate cancer, as the efficacy of such screening to decrease prostate cancer mortality has not yet been proven. Methods From the population registry men aged 50-66 years were randomized to screening (9973) and to future controls (9973). Men randomized to screening were invited to have their serum measured for free PSA (fPSA) and total PSA (tPSA) in serum using the Prostatus(R) f/tPSA assay (Perkin-Elmer, Turku, Finland). Men with a tPSA of &lt;3.0 ng/mL were not further investigated, while those with a tPSA of &amp;GE;3.0 ng/mL were investigated with a digital rectal examination (DRE), transrectal ultrasonography (TRUS) and sextant biopsies. Results Of those invited, 60% accepted PSA testing and 11.3% had a tPSA of &amp;GE;3.0 ng/mL. Altogether 145 cancers were detected (positive predictive value, PPV, 24%); none were stage M1, two were stage N+ and 10 stage T3-4. Most (59%) cancers were impalpable and 39% were both impalpable and invisible on TRUS. At biopsy, 7% were Gleason score 2-4, 71% 5-6, 19% 7 and 2% Gleason score 8-10. A threshold tPSA of &amp;GE;4.0 ng/mL would have detected 109 cancers in 366 biopsied men (PPV 30%) while cancer detection would have been 14% higher with a PPV of 36% using a threshold tPSA of &amp;GE;3.0 ng/mL combined with a f/tPSA threshold of &amp;LE;18%. Conclusion PSA screening detects early-stage low-grade prostate cancer. Both the sensitivity and specificity can be increased by incorporating f/tPSA with a tPSA threshold of &lt;4 ng/mL.},
  author       = {Hugosson, J and Aus, G and Bergdahl, S and Fernlund, Per and Frosing, R and Lodding, P and Pihl, C G and Lilja, Hans},
  issn         = {1464-4096},
  keyword      = {early detection,PSA,prostate cancer,epidemiology},
  language     = {eng},
  pages        = {39--43},
  publisher    = {Blackwell Science Ltd},
  series       = {BJU International1999-01-01+01:00},
  title        = {Population-based screening for prostate cancer by measuring free and total serum prostate-specific antigen in Sweden},
  url          = {http://dx.doi.org/},
  volume       = {92},
  year         = {2003},
}