Prostate Cancer: Screening and Early Detection
from Cancer Control: Journal of the Moffitt Cancer Center
Results of Early Detection
There is overwhelming evidence that the widespread use of PSA has resulted in the improvement of detection of prostate cancer at an earlier stage. In published data based on results of annual Prostate Cancer Awareness Week, serial screening for prostate cancer significantly improved the rate of early cancer detection. In the SEER database, the rate of distant metastases fell more than 50% between 1990-1994, a finding thought to be largely attributable to PSA use. Furthermore, in data comparing radical prostatectomy specimens from the pre-PSA era with those in the last decade, tumors in 70%-80% of men are now being detected while the tumors are still pathologically organ confined compared with less than 30% prior to the use of PSA. These findings have raised criticism that many of these PSA-detected tumors are clinically insignificant, but in fact that does not appear to the case. Recent pathology evidence from men with PSA detected tumors reveal that less than 10%-15% of all prostatectomy specimens contain what might be considered clinically insignificant tumors similar to those found at the time of autopsy. However, PSA detection alone may be inadequate if not performed as part of an early detection program, as evidenced by the large number of tumors with microscopic extraprostatic extension (up to 50% in some series) despite lack of tumor palpability.