To determine the optimal strategy for prostate cancer screening, the cost-effectiveness of screening was analyzed using a medical decision model. One hundred thousand asymptomatic males between the ages of 40 and 69 were modeled with and without screening. The subjects were divided into three 10−year age groups. We used a 5−year survival rate as an effectiveness point and assumed after 5 year survival free from prostate cancer. We considered three potential programs: 1)screening with digital rectal examination(DRE), 2)screening with prostate specific antigen(PSA), and 3)screening with a combination of DRE and PSA. The study was analyzed from the payer’s perspective, and only direct medical costs were included. For each of the three age groups, PSA screening was more cost−effective than either DRE screening or a combination of DRE and PSA screening. The cost−effectiveness ratio for the combination of DRE and PSA screening was 1.1−2.3 times more expensive than that of PSA screening. If the compliance rate for work−up exams is 80%, the cost−effectiveness of prostate cancer screening is approximate to that of gastric cancer screening. In conclusion, PSA screening is the most cost−effective strategy for prostate cancer screening when compared with both DRE and the combination of DRE and PSA screening. But prostate cancer screening should be carefully conducted, taking the cost−effectiveness of the different strategies and target groups into consideration.
Aspects of disease screening ; public service announcement ; screening for prostate cancer ; Cost aspects ; seconds

PURPOSE: This study was to examine the factors affecting prostate cancer screening behavior in Korean men using the health belief model (HBM). METHODS: It was a descriptive cross-sectional survey. A total of 121 participants answered questionnaires which included general characteristics, knowledge, and HBM variables related to prostate cancer and prostate cancer screening tests. RESULTS: Only 18 participants (14.9%) had had a prostate cancer screening test before. Participants who had had a prostate cancer screening test were more likely to perceive lower health status (odds ratio: 0.61 [95% confidence interval: 0.39, 0.93]), higher perceived sensitivity (odds ratio: 3.55 [95% confidence interval: 1.11, 11.36]), and higher self-efficacy (odds ratio: 5.77 [95% confidence interval: 1.51, 22.08]) than participants who had not had a test. CONCLUSION: We recommend developing an educational program which can increase the level of perceived sensitivity and self-efficacy to involve themselves in prostate cancer screening test actively.
Cross-Sectional Studies ; Early Detection of Cancer ; Health Behavior ; Humans ; Male ; Mass Screening* ; Prostate* ; Prostatic Neoplasms*

PURPOSE: The prevalence of prostate cancer is increasing in the general population. This study aimed to evaluate the epidemiologic characteristics of the prostate cancer detection rate. MATERIALS AND METHODS: We analyzed data from patients who underwent transrectal ultrasound-guided prostate biopsy and who were newly diagnosed with prostate cancer from 2005 to 2006 in Korea. These data were based on National Health Insurance statistics. We also analyzed the data of patients who underwent transrectal ultrasound-guided prostate biopsy and were newly diagnosed with prostate cancer in our institution from 2005 to 2007. RESULTS: According to the data of the National Health Insurance, the detection rates of prostate cancer were 45.8% in 2005 and 43.1% in 2006. These results were not actual cancer detection rates. According to the data from our institution, the cancer detection rate ranged from 24.8% to 25.9% compared with the 15.5% to 23% cancer detection rate reported by other Korean studies. We analyzed the reasons for this difference in detection rates and suggest that the difference is because a suggestive diagnosis is useful and is unchanged until the diagnosis is confirmed. CONCLUSIONS: The prevalence of prostate cancer is increasing more rapidly than that of other major cancers. The detection rate of prostate cancer in Korean patients who underwent transrectal ultrasound-guided prostate biopsy was inferior to that in Caucasians. Also, some patients were detected without proper screening or biopsy and were thus diagnosed as having advanced or metastatic prostatic cancer. We need a good corelationship between National Health Insurance and the cancer registration project for real detection of prostate cancer.
Biopsy ; Early Detection of Cancer ; Humans ; Korea ; Mass Screening ; National Health Programs ; Prevalence ; Prostate ; Prostatic Neoplasms

With the current overdiagnosis of thyroid cancer resulting from routine screening in Korea, it is necessary to educate the public that not all cancers are malignant. The exposure to patient decision aids (PtDAs) compared to usual care reduced the number of people choosing to undergo prostate-specific antigen screening. This article introduces the definition, usefulness, and developmental processes of PtDAs and suggests the urgent need for a Korean PtDA related to thyroid cancer screening.
Decision Support Systems, Clinical ; Decision Support Techniques* ; Early Detection of Cancer ; Humans ; Korea ; Mass Screening ; Prostate-Specific Antigen ; Thyroid Neoplasms

OBJECTIVES: The prostate specific antigen test is widely used as the main method of screening prostate cancer in Korea. Additionally, the use of ultrasound sonography may lead to overdiagnosis of kidney cancer as well as thyroid cancer. This study aimed to highlight epidemiological evidences regarding overdiagnosis of prostate and kidney cancers in Korean. METHODS: The annual trends of national incidence and mortality of prostate and kidney cancers provided by the Korean Statistical Information Service were evaluated. RESULTS: The rate of increase in the incidence of prostate and kidney cancer was 6 and 5 times higher than that of mortality between 2000 and 2011, respectively. Additionally, the age group showing the highest incidence in prostate cancer shifted from 85 years and older to 75-79 years. CONCLUSIONS: This evidence suggests that prostate and kidney cancers are overdiagnosed in Korea. Further research in this area, using national cancer registry databases, should be encouraged to prevent overdiagnosis.
Disease Progression ; Early Detection of Cancer ; Humans ; Incidence ; Information Services ; Kidney Neoplasms* ; Kidney* ; Korea ; Mass Screening ; Mortality ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Thyroid Neoplasms ; Ultrasonography

Prostate cancer (CaP) is the most common cancer diagnosed among men in the United States and the fifth most common cancer among men in Korea. Unfortunately, the early stages of CaP may have no symptoms. Thus, early detection is very important and physicians managing voiding dysfunction must have awareness about CaP. The traditional tests used for early detection of CaP are the prostate-specific antigen (PSA) blood test and digital rectal examination. However, a high PSA level is not specific for CaP. Benign prostatic hyperplasia, prostatitis, urinary tract infection, and urinary retention can all cause a high PSA level. Thus, no test shows sufficient accuracy to truly be useful for screening men for CaP. A prostate biopsy is the only method that yields a definitive diagnosis of CaP; however, this test is invasive and uncomfortable. Recently, new biomarkers for CaP detection have been proposed to improve the accuracy of the PSA test. In this review, we summarize our knowledge of various new biomarkers, including PSA-associated biomarkers (the prostate health index and 4Kscore), molecular biomarkers (PCA3, TMPRSS2: ERG fusion gene, and various miRNAs), and proteomics-associated biomarkers, and the ways in which they may improve the detection rate of CaP. Accordingly, this review can raise awareness about CaP to physicians managing voiding dysfunction and be a good reference for them.
Biomarkers ; Biopsy ; Diagnosis ; Digital Rectal Examination ; Discrimination (Psychology) ; Early Detection of Cancer ; Hematologic Tests ; Humans ; Korea ; Male ; Mass Screening ; Methods ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Prostatitis ; United States ; Urinary Retention ; Urinary Tract Infections

PURPOSE: The use of prostate-specific antigen as a biomarker for prostate cancer (PC) has been controversial and is, therefore, not used by many countries in their national health screening programs. The biological characteristics of PC in East Asians including Koreans and Japanese are different from those in the Western populations. Potential lifestyle risk factors for PC were evaluated with the aim of developing a risk prediction model. MATERIALS AND METHODS: A total of 1,179,172 Korean men who were cancer free from 1996 to 1997, had taken a physical examination, and completed a lifestyle questionnaire, were enrolled in our study to predict their risk for PC for the next eight years, using the Cox proportional hazards model. The model’s performance was evaluated using the C-statistic and Hosmer–Lemeshow type chi-square statistics. RESULTS: The risk prediction model studied age, height, body mass index, glucose levels, family history of cancer, the frequency of meat consumption, alcohol consumption, smoking status, and physical activity, which were all significant risk factors in a univariate analysis. The model performed very well (C statistic, 0.887; 95% confidence interval, 0.879 to 0.895) and estimated an elevated PC risk in patients who did not consume alcohol or smoke, compared to heavy alcohol consumers (hazard ratio [HR], 0.78) and current smokers (HR, 0.73) (p < 0.001). CONCLUSION: This model can be used for identifying Korean and other East Asian men who are at a high risk for developing PC, as well as for cancer screening and developing preventive health strategies.
Alcohol Drinking ; Asian Continental Ancestry Group ; Body Height ; Decision Support Techniques ; Early Detection of Cancer ; Forecasting ; Glucose ; Humans ; Life Style* ; Male ; Mass Screening ; Meat ; Motor Activity ; Physical Examination ; Population Characteristics ; Proportional Hazards Models ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Risk Factors ; Smoke ; Smoking