Validity of the prostate specific antigen test for prostate cancer screening: followup study with a bank of 21,000 sera in Finland.
OBJECTIVE
We investigate the validity of prostate specific antigen (PSA) as a screening test for prostate cancer.


METHODS
A registry of serum samples drawn from 1968 to 1976 from 21,387 men was linked to the Finnish Cancer Registry. During followup from 1968 to 1991, 104 prostate cancers were identified. A matched case control design with incidence density sampling and nested in the serum sample bank was applied, and PSA was assessed.


RESULTS
The estimated sensitivity of the test was 44% and specificity 94% at a cutoff of 4.0 microg./l. in the total material. The sensitivity had improved to 86% in patients diagnosed in 5 years after the sample drawing. The test had a better sensitivity (93%) and specificity (96%) in men younger than 65 years at the time of the sample drawing compared to those older. The sensitivity further improved to 100% with a cutoff of 2.5 microg./l.


CONCLUSIONS
PSA is a valid screening test for prostate cancer, which compares favorably with mammography for breast cancer. However, until an effect on mortality has been shown, routine screening cannot be recommended.
Hakama
M
M
Department of Public Health, Helsinki University, Tampere University School of Public Health, Finnish Cancer Registry, University Hospital of Helsinki, The National Public Health Institute, Helsinki, Finland.
Stenman
U H
UH
Aromaa
A
A
Leinonen
J
J
Hakulinen
T
T
Knekt
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001771:Blood Banks; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D017430:Prostate-Specific Antigen