FORT LAUDERDALE, Fla--Although prostate cancer screening remains
controversial because of lack of a proven effect on disease-specific
mortality, Judd Moul, MD, believes that new data regarding prostate-specific
antigen (PSA) screening, as well as statistics from the armed
forces, strongly support the benefits of screening.
Dr. Moul is a Lieutenant Colonel in the US Army Medical Corps
and director of the Center for Prostate Disease Research, Uniformed
Services University of the Health Sciences, Bethesda, Md.
In contrast to the reluctance of men in the general population
to undergo rectal examinations, soldiers are conditioned for such
screening because it is required after age 35, Dr. Moul said at
the second annual conference of Industries' Coalition Against
"History is a great teacher of the obvious," he said,
reminding the audience of a study performed 20 years ago at Walter
Reed Army Hospital. At that time, Walter Reed had a cure rate
for prostate cancer of 50%, compared with only 5% in civilian
hospitals. The reason, he believes, is that at that time the military
required an annual exam beginning at age 40, and thus prostate
cancer was found early.
Dr. Moul noted that recent findings from the Physician's Health
Study strongly support PSA screening. The 20,000 study participants,
all male physicians, had blood banked in 1982. Thirteen years
later, the blood was tested for PSA and analyzed according to
whether the men did or did not develop prostate cancer during
that time. The study found that PSA was extraordinarily sensitive
(73%) and specific (91%) for the subsequent detection of prostate
Although a PSA range of 0 to 4 ng/mL is considered normal, this
study found that any man who had a PSA greater than 1 ng/mL had
a higher relative risk of developing prostate cancer. "Between
1 and 1.5, there was a more than twofold risk of future development
of prostate cancer, and it goes up from there," he said.
Another finding challenged the maxim that men generally die with
prostate cancer, not from it. In this study, men who developed
prostate cancer had an 80% chance of dying from that cancer.