title: Screening for prostate cancer: updated experience from the Tyrol study.
abstract: OBJECTIVE
  The aim of this study was to monitor the impact of prostate cancer screening in a natural experiment by comparing prostate cancer mortality in Tyrol, Austria, where prostate-specific antigen (PSA) testing was made available at no charge, with the rest of Austria, where this screening was not introduced.
  
  
  METHODS
  In 1993, PSA testing was made freely available to men aged 40 to 79 years old living in the Federal State of Tyrol, Austria. In the first 10 years of this study, at least 70% of all men in this age range had PSA tests done at least once. Initially, only total PSA was measured, but free PSA measurement was added in 1995, and complexed PSA was added in 2001. Digital rectal examination (DRE) was not part of the screening examination.
  
  
  RESULTS
  Significant migration to lower clinical as well as pathological prostate cancer stages has been observed in patients undergoing radical prostatectomy since the introduction of this screening program. A reduction in mortality rates from prostate cancer in Austria occurred from 1993 onward, with a much greater reduction in Tyrol; mortality remained fairly constant between 1993 and 1995 and subsequently fell. From 1993 to 2000 (the most recent data), there was a significantly greater decrease in the rate of prostate cancer mortality in Tyrol compared to the rest of Austria (P value = 0.006). Based on age-specific death rates for men aged 40 to 79, the difference between the number of expected and observed deaths from prostate cancer in Tyrol was 22 in 1998 (a 42% decrease), 18 in 1999 (a 33% decrease) and 25 in 2000 (a 44% decrease).
  
  
  CONCLUSIONS
  These findings are consistent with the hypothesis that a policy of making PSA testing freely available, and 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 in mortality is likely to be due to aggressive downstaging and successful treatment and that any contribution from detecting and treating early cancers will only become apparent in the years to come.
authors.affiliation: Department of Urology, University of Innsbruck, Innsbruck, Austria.
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: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001317:Austria / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000592:standards* / Q000639:trends; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D017430:Prostate-Specific Antigen / Q000032:analysis / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D017430:Prostate-Specific Antigen