Program for prostate cancer screening using a mobile unit: results from Brazil.
OBJECTIVE
To evaluate the initial results of a prostate cancer screening program using mobile units in Brazil.


METHODS
Since 2004, we have conducted a program of prostate cancer screening using mobile units across 231 municipalities from 6 Brazilian states.


RESULTS
A total of 17 571 men were evaluated by clinical history, digital rectal examination (DRE), and serum free and total prostate-specific antigen (PSA) levels. The recommendations for biopsy were a PSA level of ≥ 4.0 ng/mL, DRE findings suspicious for cancer, or a PSA level of 2.5-4.0 ng/mL with a percent-free PSA level < 15%. The biopsy protocol included 12 biopsy cores from the peripheral zone, 2 from the transition zone, and additional sampling of suspicious areas. The cumulative cancer detection rate was 3.7%. The main indication for biopsy was a PSA level of ≥ 4.0 ng/mL (51.2%), with a positive predictive value (PPV) of 44.1%. Another 19.7% of biopsied men had suspicious DRE findings with a normal PSA level (PPV 23.5%). A percent-free PSA level of < 15% in men with a PSA level of 2.5-4.0 ng/mL and normal DRE findings yielded a PPV of 31.1%. The PPV was greater (70.9%) for the 7.1% of men with both suspicious DRE findings and a PSA level of ≥ 4.0 ng/mL. Most cancers were Stage T1-T2 (93.4%), and the percentage of Gleason score of ≥ 7 was 32.5%. The proportion of insignificant cancers according to Epstein's criteria was 13.5%.


CONCLUSIONS
A mobile prostate cancer screening unit enabled an underserved population to gain access to specialized care through the public healthcare system. The cancer detection rate in this population was similar to those from international studies.
Faria
Eliney F
EF
Division of Urology, Barretos Cancer Hospital, São Paulo, São Paulo, Brazil. elineyferreirafaria@yahoo.com.br
Carvalhal
Gustavo F
GF
Vieira
René A C
RA
Silva
Thiago B
TB
Mauad
Edmundo C
EC
Carvalho
André L
AL
D000368:Aged; D001707:Biopsy, Needle; D001938:Brazil; D051517:Digital Rectal Examination; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D008952:Mobile Health Units; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology
D017430:Prostate-Specific Antigen