Early detection of prostate cancer following repeated examinations by multiple modalities: results of the American Cancer Society National Prostate Cancer Detection Project.

The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) is a multicenter, interdisciplinary demonstration project to assess the impact on early detection of transrectal ultrasound (TRUS), prostate-specific antigen (PSA), and digital rectal examination (DRE). Preliminary data are available from the first 3-5 y of planned observation. The results show declining rates of detection for each succeeding examination. Cancer detection rates are highly dependent on age. The positive predictive value of a solitary examination is low regardless of modality, but any combination of positive results has a much better predictive value. The cancers detected were predominantly clinically localized tumors, and detection of advanced stage cancer was uncommon after the initial examination. Radical prostatectomy was the most common form of treatment. These findings have implications for prostate cancer early detection guidelines and practice.