The value of prostatic specific antigen in prostate cancer screening in the community.

At a one-day screening for prostate cancer in 1991, a urologist evaluated 142 men ages 50 years-84 years (mean: 67 years) utilizing a digital rectal exam (DRE), serum prostatic specific antigen (PSA), and a detailed questionnaire. The 44 men with an abnormal DRE and/or PSA were recontacted by letter one year later to determine the outcome. By 12 months, 31 men (70%) with abnormal findings had seen a physician as recommended. Of the 13 men followed with abnormal DRE only, three were biopsied with no cancer found. Of the 11 with an elevated PSA only, six were biopsied and two had cancer. Of the men with both abnormal PSA and DRE, six were biopsied and two had cancer. Thus, after 12 months, the preliminary cancer detection rate was 2.8% for the entire study population, 22% for those with an elevated PSA, and 10% for those with an abnormal DRE. The results suggest that the use of PSA combined with DRE is a more efficient strategy for detecting prostate cancer than DRE alone.