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 Cancer .
"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 cancer.
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.