Prostate screening--the Singapore experience.

Background: The prevalence of benign prostatic hyperplasia (BPH) is believed to be highly significant in most communities. In our country, many elderly men are unaware that something can be done for their troublesome urinary symptoms. The main objective of our prostate health screening was to educate our elderly male population that this is an abnormality, for which treatment is readily available. At the same time, we attempted to determine the prevalence of BPH, to detect possible prostate cancer, and to derive normal prostate specific antigen (PSA) and uroflow values for our population.

Methods: Over an eight-day period in April 1994, 799 men above the age of 50 years volunteered to participate in a free prostate screening exercise held at our hospital. The parameters assessed were PSA level, American Urological Association (AUA) symptom score, uroflowmetry, and digital rectal examination (DRE) of the prostate.

Results: Elevated PSA levels of more than 4 micrograms/L were detected in 105 men (13.1%). Of these, 23 men (2.9%) had PSA values above 10 micrograms/L. Abnormal AUA symptom scores of more than eight (moderate and severe categories) were noted in 540 men (67.6%). Clinically enlarged prostate glands of more than 20 g on DRE were noted in 80 men (10.0%), and abnormal DRE findings were detected in 48 men (6.01%). Impaired maximal uroflow rates of less than 10 mL/s were recorded in 224 men (39%), while another 167 men (29.1%) had maximal uroflow values in the equivocal zone (between 10 to 15 mL/s). The reference PSA levels at the 5th percentile, 10th percentile, median, mean, 90th percentile and 95th percentile were 0.38, 0.47, 1.05, 1.57, 3.27 and 4.25 micrograms/L, respectively. The age-specific PSA values were 3.51, 3.78 and 6.02 micrograms/L in the 50 to 59, 60 to 69, and 70 to 79 years age groups, respectively, and the reference mean maximal uroflow rates was 14.8 mL/s.

Conclusions: Although controversial, our experience with prostate screening was generally positive. As far as our population is concerned, the free prostate screening exercise generated publicity, and succeeded in enhancing public awareness for better prostate health.