title: Prostate specific antigen based biennial screening is sufficient to detect almost all prostate cancers while still curable.
abstract: OBJECTIVE
  We evaluated whether biennial screening with prostate specific antigen (PSA) only is sufficient to detect prostate cancer while still curable.
  
  
  METHODS
  In Göteborg, Sweden 9,972 men 50 to 65 years old were randomized to PSA screening. During 1995 and 1996 these men were invited for a first PSA screening and invited during 1997 and 1998 for a second screening. The screening procedure included PSA measurement in all men and in those with a PSA of 3 ng./ml. or greater also it included digital rectal examination, transrectal ultrasound and sextant biopsies.
  
  
  RESULTS
  In the first screening 5,854 men participated and 145 cancers were detected. In the second screening 5,267 men participated and 111 cancers were detected. Only 9 interval cancers were diagnosed. In the second screening 102 cancers (92%) were associated with PSA less than 10 ng./ml. Of 465 men with increased PSA and who underwent biopsy with a benign outcome in the first screening 50 had cancer at the second screening. Of 241 men in whom PSA increased between screenings 1 and 2 cancer was detected in 46. None of the 2,950 men with an initial PSA of less than 1 ng./ml. had a PSA of greater than 3 ng./ml. or interval cancer.
  
  
  CONCLUSIONS
  In men with a PSA of less than 2 ng./ml. it seems safe to offer repeat screening after 2 years with PSA only. Men with a PSA of 2 to 3 ng./ml. or a value of greater than 3 ng./ml. with negative biopsy may be better served by a shorter screening interval. Thus, different screening intervals are implied depending on baseline PSA.
authors.affiliation: Department of Urology, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Aus
authors.forename: Hans
authors.initials: H
authors.lastname: Lilja
authors.forename: Pär
authors.initials: P
authors.lastname: Lodding
authors.forename: Carl Gustaf
authors.initials: CG
authors.lastname: Pihl
authors.forename: Erik
authors.initials: E
authors.lastname: Pileblad
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis*; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen