title: Screening for prostate cancer: updated experience from the Tyrol study.
abstract: The aim of the Tyrol study was to monitor the impact of screening in a natural experiment by comparing prostate cancer mortality in Tyrol, where prostate-specific antigen (PSA) testing was introduced at no charge, with the rest of Austria, where it was not strictly organized and not free of charge. In 1993, PSA testing was made freely available to men between the ages of 45 and 75 years in the Federal State of Tyrol, Austria. At least 70% of all of the men in this age range have been tested at least once during the first 10 years of the study. Initially, only total PSA was measured, but free PSA measurement was added in 1995. Since 2001, complexed PSA also has been measured. Digital rectal examination was not part of the screening examination. Significant migration to lower clinical and pathological stages has been observed since the introduction of this screening program. These findings are consistent with the hypothesis that the policy of making PSA testing freely available, and the wide acceptance by men in the population, is associated with a reduction in prostate cancer mortality in an area in which urology services and radiotherapy are available freely to all patients. It is our opinion that most of this decline is likely a result of aggressive downstaging and successful treatment and that any contribution from detecting and treating early cancers will become apparent in the years to come.
authors.affiliation: Department of Urology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. wolfgang.horninger@uibk.ac.at
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
authors.forename: Andreas
authors.initials: A
authors.lastname: Berger
authors.forename: Alexandre
authors.initials: A
authors.lastname: Pelzer
authors.forename: Helmut
authors.initials: H
authors.lastname: Klocker
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Oberaigner
authors.forename: Dieter
authors.initials: D
authors.lastname: Schönitzer
authors.forename: Gianluca
authors.initials: G
authors.lastname: Severi
authors.forename: Chris
authors.initials: C
authors.lastname: Robertson
authors.forename: Peter
authors.initials: P
authors.lastname: Boyle
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D005251:Fees, Medical; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D015397:Program Evaluation; D017430:Prostate-Specific Antigen / Q000097:blood* / Q000191:economics; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality*
chemical_list: D017430:Prostate-Specific Antigen