80984
document
Optimized strategy for detection of early stage , curable prostate cancer : role of prescreening with prostate-specific antigen . In 1,002 men aged 45-80 y , 81 % of the cancers detectable by serum prostate-specific antigen ( PSA ) , digital rectal examination ( DRE ) , and transrectal ultrasonography ( TRUS ) were present in a subpopulation ( 19 % of total ) identified by serum PSA above the threshold value of 3.0 micrograms/L . This study was extended to 7,350 men using serum PSA and DRE as first approach , followed by TRUS only when 1 of these 2 tests was abnormal . Because the aim of prostate cancer detection is to find cancers at an early , potentially curable stage , it is of major interest that 71.8 % of evaluable cancers were clinical stage B ; 8.4 % and 10.7 % were stages C1 and C2 , respectively ; only 9.2 % were stage D ( metastatic ) at first visit while none was at stage D at follow-up visits . This study , the first performed in an unselected , unscreened population , shows that serum PSA is the most sensitive technique to identify men at high risk of having prostate cancer and that 12 % more cancers can be found at first visit by doing DRE in addition to PSA . Follow-ups can be done every second year using serum PSA alone , as 97 % of the cancers detected at annual follow-up by DRE + PSA were PSA+ . Cancers are discovered by the present approach at an estimated cost of $ 2,665 per cancer . Such cancers are potentially curable in at least 80 % of cases detected at first visit and in 97 % of cases at follow-up . This strategy offers the possibility to improve markedly morbidity and mortality from prostate cancer , presently the second leading cause of cancer death in North American men .
80985
Intervention_Pharmacological
serum prostate-specific antigen ( PSA )
80986
Intervention_Physical
digital rectal examination ( DRE )
80987
Intervention_Physical
transrectal ultrasonography ( TRUS )
80988
Intervention_Pharmacological
PSA
80989
Intervention_Physical
DRE
80990
Intervention_Surgical
TRUS
80991
Intervention_Pharmacological
PSA
80992
Intervention_Physical
DRE
80993
Intervention_Pharmacological
PSA
80994
Intervention_Pharmacological
PSA
80995
Intervention_Physical
DRE
80996
Intervention_Pharmacological
PSA
80997
Intervention_Pharmacological
PSA+
80998
Outcome_Physical
serum prostate-specific antigen ( PSA )
80999
Outcome_Physical
digital rectal examination ( DRE )
81000
Outcome_Physical
transrectal ultrasonography ( TRUS )
81001
Outcome_Physical
serum PSA
81002
Outcome_Physical
sensitive technique
81003
Outcome_Physical
risk of having prostate cancer
81004
Outcome_Physical
serum PSA alone
81005
Outcome_Other
estimated cost
81006
Outcome_Other
curable
81007
Outcome_Mortality
morbidity and mortality from prostate cancer