[Estimating standard performance measures of opportunistic screening for prostate cancer].
OBJECTIVE
to estimate the standard performance measures of prostate-specific antigen (PSA) screening as implemented in the existing health care system and to compare the observed results with those fom the European Randomized Screening for Prostate Cancer (ERSPC) trial.


METHODS
in a consecutive series of men living in two Italian health districts, aged > or = 30 years, with at least one total PSA test between 2000 and 2003, those subjects putatively tested for screening purposes were identified using record linkage with multiple local health databases. This was also used to determine the outcomes of follow-up of subjects with positive test result (PSA > or = 4 ng/ml) at 12 and 24 months of observation.


METHODS
clinical chemistry laboratories, outpatient urology clinics, pathology departments, and mortality registries of the health districts of Ravenna and Forlì, and the Romagna Cancer Registry.


METHODS
52,513 total subjects, 42,398 of whom putatively tested for screening purposes.


METHODS
the most common performance measures of cancer screening.


RESULTS
the 2-year screening rate increased until 80 years of age. In the age range 55-69 years, i.e. the target age of the ERSPC trial, the screening rate was 38.1%, and the rate of positive test results (9.1%) was within the expected range. The PSA level, but not the subjects age, was strongly associated with follow-up procedures. After 24 months of observation, 24.4% PSA-positive patients received no further evaluation, 54.8% underwent repeat testing as the initial follow-up action, and 44.0% were referred for urologic assessment. The biopsy rate was 25.3%, the positive predictive value of PSA testing 10.1%, the detection rate of prostate cancer 9.4 per thousand, and the detected/expected ratio 8.4.


CONCLUSIONS
compared with methods and results of the ERSPC trial, the management of PSA-positive subjects was much more conservative, and the yield of disease much smaller.
Leoni
Maurizio
M
Divisione di oncologia medica, Ospedale Santa Maria delle Croci, Ravenna.
Falcini
Fabio
F
Ravaioli
Alessandra
A
Foca
Flavia
F
Andalò
Gianni
G
Benini
Franca
F
Dal Pozzo
Claudio
C
Ricci
Rosalba
R
Naldoni
Carlo
C
Bucchi
Lauro
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy / Q000379:methods; D055088:Early Detection of Cancer; D005820:Genetic Testing; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000473:pathology
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen