Screening for prostate cancer in military populations.

With the widespread use of the prostate-specific antigen (PSA) test, smaller cancers are being detected among younger men and 5-year, cancer-specific, survival rates are on the rise. Although this lead-time effect may not translate into long-term improvement, these changes are a necessary prerequisite to effective screening. For high-risk patients, i.e., men with a family history of the disease and African American men, a strategy consisting of annual PSA blood testing and digital rectal examination for men > or = 40 years of age appears prudent. Many low/average-risk men of age 40 to 49 also request testing, and it is reasonable to offer testing and risk assessment to them. The exact screening threshold for total PSA levels for these men is not known, but 95% have PSA levels of < or = 1.5 to 2.5 ng/mL. PSA velocity (< 20% per year), percentage of free PSA (> 18-25%), and complexed PSA levels may be used to help determine risk. More study of young men is needed.