HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE COVER ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Submit a letter to the editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Littrup, P. J. Articles by Mettlin, C. Search for Related Content PubMed PubMed Citation Articles by Littrup, P. J. Articles by Mettlin, C.

CA: A Cancer Journal for Clinicians, Vol 42, Issue 4 198-211, Copyright © 1992 by American Cancer Society

ARTICLES

Prostate cancer screening: current trends and future implications

P. J. Littrup, F. Lee and C. Mettlin
Department of Radiology, St. Joseph Mercy Hospital, Ann Arbor, Michigan.

Screening for prostate cancer represents a clinical dilemma with no clear evidence to suggest decreased mortality from any diagnostic test. We now possess new knowledge regarding optimal combinations of DRE, TRUS, and PSA. While DRE and TRUS may be too subjective and PSA too nonspecific, their combined predictive values identify not only men at high risk but also those for whom continued frequent screening may not be cost effective. A monoclonal PSA decision level of no more than 4.0 ng/ml should be used, since 40 percent of cancers detected from 4.0 to 10.0 ng/ml already have extracapsular extension. Assuming that DRE is performed by experienced examiners, the combination of PSA and DRE should produce cost-effective early detection and minimize missed cancers below 4.0 ng/ml. TRUS should be reserved for those patients with either PSA elevations and/or DRE abnormalities. The use of TRUS gland volume data to further modify PSA decision levels, such as the "predicted" PSA concept, may also improve TRUS biopsy criteria and predictive values. Prostate cancer detection can then be objectively limited to a small percentage of the population and better selected for earlier, more localized disease. The ultimate decrease in mortality from screening remains to be demonstrated in randomized trials or observed only after decades of increased public awareness about prompt early detection combined with effective, definitive therapy.

This article has been cited by other articles:

				E. Kuligowska, M. A. Barish, H. M. Fenlon, and M. Blake Predictors of Prostate Carcinoma: Accuracy of Gray-Scale and Color Doppler US and Serum Markers Radiology, September 1, 2001; 220(3): 757 - 764. [Abstract] [Full Text] [PDF]

				R. B. Williams, M. Boles, and R. E. Johnson Use of Prostate-Specific Antigen for Prostate Cancer Screening in Primary Care Practice Arch Fam Med, April 1, 1995; 4(4): 311 - 315. [Abstract] [PDF]

				W. E. Broadhead, A. C. Leon, M. M. Weissman, J. E. Barrett, R. S. Blacklow, T. T. Gilbert, M. B. Keller, M. Olfson, and E. S. Higgins Development and Validation of the SDDS-PC Screen for Multiple Mental Disorders in Primary Care Arch Fam Med, March 1, 1995; 4(3): 211 - 219. [Abstract] [PDF]

				R. Y. Demers, G. M. Swanson, L. K. Weiss, and T.-Y. Kau Increasing Incidence of Cancer of the Prostate: The Experience of Black and White Men in the Detroit Metropolitan Area Arch Intern Med, June 13, 1994; 154(11): 1211 - 1216. [Abstract] [PDF]

				N. K. Skelton and W. P. Skelton III Changing Physician PSA Ordering Patterns Through Education Arch Intern Med, April 11, 1994; 154(7): 819 - 820. [Abstract] [PDF]