Article

Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination.

Harvard University, Cambridge, Massachusetts, United States
Urology (Impact Factor: 2.13). 10/1993; 42(4):365-74. DOI: 10.1016/0090-4295(93)90359-I
Source: PubMed

ABSTRACT This study was designed to determine the effects of age by decade on the efficacy of digital rectal examination (DRE) and serum prostate-specific antigen (PSA) for early detection of prostate cancer in men aged fifty and over. A prospective multicenter clinical trial was conducted at six university centers. All 6,630 male volunteers underwent a serum PSA (Hybritech, Tandem) determination and DRE. Quadrant biopsies of the prostate were performed if PSA was > 4 ng/mL or DRE suspicious. A total of 1,167 biopsies were performed, and 264 cancers were detected. The cancer detection rate increased from 3 percent in men aged fifty to fifty-nine to 14 percent in men eighty years or older (p < 0.0001). PSA detected significantly more of the total cancers than DRE at all age ranges (p < 0.05). The positive predictive values (PPV) for PSA were 32 percent (50-59 years), 30 percent (60-69 years), 34 percent (70-79 years), and 38 percent (80+ years). The corresponding PPVs for DRE were 17 percent, 21 percent, 25 percent, and 38 percent. Eighteen percent of the cancers were detected solely by DRE, whereas 45 percent of cancers were detected solely by PSA. Thus, the use of both tests in combination provided the highest rate of detection in all age groups. One hundred-sixty patients underwent radical prostatectomy and pathologic staging. Cancer was organ-confined in 74 percent (25/34) of men aged fifty to fifty-nine, 76 percent (65/86) of men aged sixty to sixty-nine, and 60 percent (24/40) of men aged seventy or over (chi 2, < 70 vs. > or = 70, p < 0.05). Early detection programs yield a lower, yet still substantial, cancer detection rate in younger men, and there is a greater likelihood for detection of organ-confined disease in this age range. Younger men have the longest projected life expectancy and, therefore, the most to gain from early prostate cancer detection.

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    • "Importantly, screening with PSA alone was unable to detect all men with aggressive PCa as evidenced by the current findings in which most aggressive cancers were interval cancers found outside of the normal screening. When combined with a baseline PSA level, a digital rectal examination (DRE) may increase the rate of detecting PCa at the initial screen [9]. The AUA guidelines on PCa recommend the combination of a PSA level and DRE for those men requesting to be screened for PCa. "
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    • "Future analyses will allow comparison to these data. Some series have documented that younger patients have a significantly higher rate of organ-confined disease than older men [28]. Carter et al. [7] reported that age at diagnosis may be a stronger predictor of prostate cancer curability than differences in pre-treatment PSA. "
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