[Early detection of prostate cancer-results of a prostate specific antigen-based detection program at a "multiphasic...

Determination was made of serum PSA in the early detection of prostate cancer in a population of 1,227 men aged 55 years or older who visited a "human dock". "Human dock" is a unique health examination facility open to public in Japan. Recommendation for biopsy was made based solely on this parameter when its value exceeded 2.0 ng/ml in IMx immunoenzymetric assay (Dinabot Co.). Of these, 162 (13.2%) had elevated values. The proportion of males with serum PSA greater than 4.0 ng/ml was only 3.6%. Of the 109 males who underwent ultrasound guided biopsies, 17 cancers were detected, the cancer detection rate thus being 1.4%. Most of these cases (82.4%) were clinically localized cancers. Eight patients with cancer had serum PSA levels below 4.0 ng/ml including 6 less than 3.0 ng/ml. Radical prostatectomy was conducted on 14 patients. All had histologic features of clinically significant cancer and 64.3% were pathologically confined. Oriental elderly males appear to have lower serum PSA than western counterparts. The optimal cutoff of serum PSA for early detection should be examined further in oriental male populations. Differences in the incidence of prostate cancer between ethnic groups may have been overestimated in previous studies owing in part to unawareness by the physician and general public. Though the application of PSA for early detection will likely disclose greater numbers of prostate cancers in Japan, whether early detection reduces mortality by minimizing risk of death from cancer remains a point to be clarified.