title: Population-based screening for prostate cancer by measuring total serum prostate-specific antigen in Iran.
abstract: OBJECTIVE
  To report the results from an Iranian large population-based randomized study of screening using prostate-specific antigen (PSA) to detect prostate cancer.
  
  
  METHODS
  A total of 3758 Iranian men older than 40 years were mass checked by PSA-based screening. Men with an abnormal digital rectal examination (DRE) and serum total PSA level of greater than 4 ng/mL, underwent transrectal ultrasonography (TRUS)-guided extended prostate biopsy.
  
  
  RESULTS
  The PSA value (mean +/- standard deviation, SD) in all men without prostate cancer was 1.6 +/- 1.1 ng/mL and in those with cancer 18 +/- 44.8 ng/mL (P = 0.001). PSA values increased with age. In those aged 40-49, 50-59, 60-69 and > or = 70 years, the mean +/- SD PSA values were 1.3 +/- 0.7, 1.4 +/- 0.8, 1.8 +/- 1 and 2.2 +/- 1.6 ng/mL, respectively. Among the screened men, 323 (8.6%) had a serum PSA concentration greater than 4 ng/mL. Of patients who underwent prostate biopsy (230, 71.2%), 129 (positive predictive value, 56.1%) had prostate cancer. Additionally, nine cancers were detected among 16 patients with PSA of less than 4 ng/mL who had a doubtful DRE finding. The overall cancer detection rate was 3.6%; 1.4% at 40-49, 1.6% at 50-59, 4.2% at 60-69 and 12.9% at >/=70 years. Conventional systematic sextant biopsies, which accounted for six of the 10 cores in our biopsy scheme, detected 98 (71%) of the cancers.
  
  
  CONCLUSIONS
  The Iranian male population develops prostate cancer quite commonly if their serum PSA levels are greater than 4.0 ng/mL. In this study, 65.9% of the detected cancers were clinically significant. The conventional systematic sextant technique may be inappropriate for detection of all prostate cancers. The results need to be confirmed in other randomized trials.
authors.affiliation: Urology and Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Atomic Energy Organization, Nuclear Research Center, Radioisotope Production Section, Tehran, Iran.
authors.forename: Seyyed Yousof
authors.initials: SY
authors.lastname: Hosseini
authors.forename: Massood
authors.initials: M
authors.lastname: Moharramzadeh
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Ghadian
authors.forename: Hassan
authors.initials: H
authors.lastname: Hooshyar
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Lashay
authors.forename: Mohammah Reza
authors.initials: MR
authors.lastname: Safarinejad
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D007492:Iran; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis*
chemical_list: D017430:Prostate-Specific Antigen