title: Ten year trend in prostate cancer screening with high prostate-specific antigen exposure rate in Japan.
abstract: BACKGROUND
  The tendency of the results and quality control of prostate cancer screening serially performed for 10 years in an area of Japan were evaluated.
  
  
  METHODS
  A total of 39 213 men over 55 years of age have participated in the mass screening of prostate cancer in the Otokuni District, since 1995. Men whose prostate-specific antigen (PSA) levels were more than 4.1 ng/mL were indicated for the second screening. In the second screening, prostate-specific antigen density (PSAD) was calculated in men whose PSA levels ranged from 4.1 to 10.0 ng/mL.
  
  
  RESULTS
  Secondary screening was indicated in a total of 2428 subjects, of whom 1633 underwent it. Prostate cancer was diagnosed in 267 men. As a result of the evaluation of the indication of prostate biopsy according to the PSAD in 894 who underwent secondary screening for the first time, the procedure was judged to be unnecessary in 269 (35%) of 765 cases. Of these 269 subjects, 23 (8.5%) were found to have cancer. Clinically localized prostate cancer increased by 17%, and locally advanced and metastatic cancers decreased by 12% in the second compared with the first five years of the ten-year period. The exposure rate of PSA screening in the Otokuni District was 65% with the application for the rate of screenees whose PSA level was 4.1 ng/mL or above.
  
  
  CONCLUSIONS
  The Japanese basic health screening system allows the determination of high-PSA exposure areas. Serial prostate cancer screening showed a tendency of stage migration in the screened cancer patients. The use of PSAD in secondary screening substantially reduces the necessity of prostate biopsy; however, the encouragement of PSA-positive individuals to periodically receive prostate cancer screening is essential to maintain the quality of the screening system.
authors.affiliation: Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan. okihara@koto.kpu-m.ac.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Okihara
authors.forename: Koji
authors.initials: K
authors.lastname: Kitamura
authors.forename: Koichi
authors.initials: K
authors.lastname: Okada
authors.forename: Kazuya
authors.initials: K
authors.lastname: Mikami
authors.forename: Osamu
authors.initials: O
authors.lastname: Ukimura
authors.forename: Tsuneharu
authors.initials: T
authors.lastname: Miki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends*; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology
chemical_list: D017430:Prostate-Specific Antigen