Clinical and pathological characteristics of screen-detected versus clinically diagnosed prostate cancer in Nanjing, China

Previous studies have suggested that implementation of PSA screening in China is of crucial importance. This study compared clinical and pathological characteristics of screen-detected and clinically diagnosed prostate cancers and evaluated the effectiveness of PSA screening for early detection of prostate cancer in Nanjing. Between July 2004 and December 2005, 8,562 men aged ≥50 years were included for PSA screening. Participants with serum PSA ≥4.0 ng/ml were recommended for transrectal ultrasonography (TRUS)-guided prostate needle biopsy (TRNB). During the same period, 82 consecutive clinically diagnosed prostate cancers were included as controls. The clinical and pathological features of the screened versus clinically diagnosed cancers were evaluated. A total of 719 (8.4%) of screened men had PSA levels ≥4.0 ng/ml. Biopsy was performed in 295 men, and 58 prostate cancers were detected. The biopsy rate, positive predictive value (PPV), and detection rate were 41.0, 19.7, and 0.68%, respectively. More screened patients were found with PSA levels <20 ng/ml (55.2 vs. 22.4%, P < 0.001), Gleason scores <7 (60.3 vs. 34.1%, P = 0.002), organ-confined tumors (87.9 vs. 26.8%, P < 0.001), and opportunities for radical prostatectomy (50.0 vs. 18.3%, P < 0.001) than that in clinically diagnosed patients. PSA screening is effective for early detection of prostate cancer in Chinese elderly men. Favorable PSA levels, Gleason scores, clinical stages, and chances for radical prostatectomy are associated with PSA screening. Further studies are needed to evaluate the effect of screening on treatment outcomes and mortality of prostate cancer in Chinese.