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Prostate cancer screening practices examined

ical history. The PLCO protocol advises men to consult their own physician if either the PSA or DRE tests given by PLCO are suggestive of cancerous growth.

The outcome of the study should aid patients and doctors in making decisions about diagnosis and treatment of prostate cancer. "It's a complex decision," Andriole explains. "Say your father had an abnormal PSA test, and he's 76 and has a bad heart, diabetes, or recently had a stroke. Frankly, the patient and doctor have to base their decision on the probability that one of those factors may cause death before prostate cancer."

Of the men screened by PLCO, about 14 percent had positive screening results, indicative of possible cancer. Approximately 8 percent screened positive by PSA test, and about 7 percent screened positive by DRE test. Only about 1 percent of these results overlapped, demonstrating the importance of using both screening methods.

"We were hopeful some years ago that men could just have the PSA blood test, because men hate the rectal exam," Andriole says. "We've found that if you omit the DRE, you'll miss a certain percentage of cancers."

Three-fourths of the men with positive PLCO screens went in for further diagnostic evaluation with their personal physician. The physicians would decide whether to conduct their own screenings and whether to subsequently perform a biopsy, which is needed to confirm the presence of cancer before treatment.

About a third of men with abnormal tests had a prostatic biopsy within a year of the initial screen. Of men with PSA readings higher than normal, 64 percent underwent biopsy within three years. The higher the PSA readings, the higher the biopsy rates. The biopsy rate in men with positive DRE alone was 28 percent.

The initial data indicate that younger men, men with a family history of prostate cancer and African American men are more likely to have a biopsy after an abnormal screening result. "These statistics p
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Contact: Gwen Ericson
ericsong@wustl.edu
314-286-0141
Washington University School of Medicine
15-Mar-2005


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