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At least 127 records · Page 7Linked to original sources

PubMed2005

Prediction of extraprostatic extension in the neurovascular bundle based on prostate needle biopsy pathology, serum prostate specific antigen and digital rectal examination.

PURPOSE: There are few studies on predictors of extraprostatic extension (EPE) in the region of the neurovascular bundle (NVB). We investigated whether clinical information and prostate biopsy data could predict EPE of clinical localized prostate cancer. MATERIALS AND METHODS: Through a retrospective analysis of the pathology database we identified 2,660 cases of clinically localized prostate cancer treated with radical retropubic prostatectomy without preoperative adjuvant therapy at The Johns Hopkins Hospital. The study sample involved a total of 3,006 lobes with prostate cancer including 2,070 with organ confined disease, 620 with EPE in the NVB at the posterolateral edge of the prostate and 316 with EPE in a region other than the NVB (EPE elsewhere). Through univariate and multivariate logistic regression analysis we determined whether patient age, year of surgery, serum prostate specific antigen, digital rectal examination, biopsy highest Gleason score, perineural invasion, percent of side specific biopsy cores with cancer, percent of each core involved with cancer and the maximum percent of a core involved with cancer was predictive of EPE in the NVB. RESULTS: Prostate specific antigen (10 or greater vs less than 10), biopsy Gleason score (7 or greater vs 6 or less), digital rectal examination (abnormal vs normal), percent of side specific cores with tumor (greater than 33.3% vs 33.3% or less) and average percent involvement of each positive core (greater than 20% vs 20% or less) were all found to be statistically significant independent predictors of NVB penetration in multivariate analysis. The generated model stratifies each of these variables into high and low risk. The probability of EPE in the NVB was less than 10% in cases with 1 or fewer of the higher risk variables and was 10% or greater in cases with more than 1 of the higher risk variables. CONCLUSIONS: The model generated in this study allows for the preoperative identification of patients with 10% or greater probability of EPE in the NVB. Our algorithm will help provide objective parameters that aid in the decision to spare the NVB safely.

Biopsy, Needle↗

PubMed2000

[Early detection of prostatic carcinoma in urologic practice with digital rectal examination and prostate-specific antigen. Early Detection Project Group].

For the early detection of prostate cancer, a patient should undergo digital rectal examination (DRE) and PSA investigation. Follow-up of increased PSA levels detects nearly 80% of cancers. Positive predictive value of suspicious DRE and PSA is about 50%. Whereas in the first evaluation of this case-finding trial about 70% of the patients had organ-confined cancers, nearly all of the detected cancers in the follow-up investigation were organ confined. The increased number of organ-confined cancers detected in early periodical examinations can lead to a reduction of mortality and morbidity from prostate cancer.

Adult↗

PubMed2005

The utility of digital rectal examination after radical radiotherapy for prostate cancer.

AIMS: The aim of the current study was to determine the utility of routine digital rectal examination (DRE) after radical radiotherapy for prostate cancer. MATERIALS AND METHODS: Between 1990 and 1999, 899 patients with clinically localised prostatic adenocarcinoma (T1-4, N0/Nx, M0/Mx) underwent neoadjuvant androgen deprivation and radical radiotherapy at the Royal Marsden Hospital. Patients were followed with serum prostate-specific antigen (PSA) test and DRE carried out at 6-monthly intervals for the first 2 years, and then annually. RESULTS: At a median follow-up of 5 years, 39 out of 899 cases (4.3%) had local recurrence detected on DRE. DRE failed to detect any local recurrences in the absence of a rising PSA. The lowest serum PSA concentration at the time of clinically detectable local recurrence was 1.7 ng/ml. CONCLUSIONS: These findings question the standard model of follow-up after radiotherapy for prostate cancer, and suggest that alternatives, such as telephone clinics, should be considered.

Adenocarcinoma↗

PubMed1999

Development of a nomogram that predicts the probability of a positive prostate biopsy in men with an abnormal digital rectal examination and a prostate-specific antigen between 0 and 4 ng/mL.

OBJECTIVES: Early detection of prostate cancer traditionally involves both digital rectal examination (DRE) and serum prostate-specific antigen (PSA) determination in an informed patient population. Abnormalities in either of these studies typically lead to additional evaluations, including prostate biopsy. In this study, we analyzed the operational characteristics of serum PSA between 0 and 4 ng/mL as an initial test for prostate cancer. METHODS: From January 1990 through May 1997, transrectal biopsies were obtained from 700 men with a serum PSA level less than 4.0 ng/mL but DRE suspicious for cancer. Patient age, race, and serum PSA level were reviewed for this study. RESULTS: Of the 700 men studied, 445 were white (64%) and 255 were African American (36%). In multivariate analysis of prebiopsy risk factors (age, race, serum PSA), serum PSA was the only independent predictor of a positive prostate biopsy. A nomogram was created that determines the worst-case probability of a positive prostate biopsy in men with PSA between 0 and 4 ng/mL and a DRE suspicious for cancer. The predictions from the nomogram appeared accurate and discriminating, with a bias-corrected area under the receiver operating characteristic curve (i.e., comparison of the predicted probability with the actual outcome) of 0.75. CONCLUSIONS: Although early detection of prostate cancer has traditionally used both PSA measurement and DRE, PSA testing alone could be more easily implemented and may encourage some men to seek consultation who might not otherwise have done so. By providing a nomogram which provides a worse-case scenario (assuming a positive DRE) of the probability of a positive biopsy, the patient and clinician can make an informed decision as to whether additional evaluation is warranted.

Adult↗

PubMed1999

Intraindividual variations of total and percent free serum prostatic-specific antigen levels in patients with normal digital rectal examination.

PURPOSE: To analyze intraindividual variations of total and percent free serum prostate-specific antigen (PSA) in patients with normal digital rectal examination. MATERIAL AND METHODS: Total and free serum PSA were determined in two blood samples corresponding to 107 nonconsecutive patients. The period between both determinations ranged from 23 to 60 days. Prostatic biopsy was done after both determinations in all except 17 patients because the two serum PSA concentrations were <4 ng/ml. Total and free PSA were determined using double monoclonal antibody immunoassay Tandem and Tandem free (Hybritech Inc.). The diagnosis was benign prostatic hyperplasia (BPH) in 63 patients and prostate cancer (PCA) in 44. RESULTS: The variations of PSA ranged between -6.8 and +3.2 ng/ml in BPH patients and between -2.8 and +9.0 in patients with PCA. The median coefficients of variation were 15.4 and 15.7% respectively. The variations in the percent free PSA were between -30.7 and +40.9 in the BPH group and between -17.9 and +15.8 in the PCA group. The median coefficients of variation were 32.2 and 32.3% respectively. If prostatic biopsy had been indicated when percent free PSA had been </=25 in the PSA range of 4.1-10 ng/ml, we would have found discrepancies in 15% of all the patients. The sensitivity for the first determination would have been 100 and 94.4% for the second. The rate of negative biopsies would have been reduced by 16.6 and 19. 4% respectively. CONCLUSIONS: Intraindividual variations in serum PSA concentration and percent free PSA could have clinical implications in the decision to perform prostatic biopsy.

Aged↗

PubMed1993

Is transrectal ultrasonography needed to rule out prostatic cancer with normal findings at digital rectal examination and normal serum prostate-specific antigen?

In a prospective study, 288 consecutive patients without evidence for prostatic carcinoma at digital rectal examination (DRE) and scheduled for prostatectomy because of benign prostatic hyperplasia (BPH) were examined by transrectal ultrasonography (TRUS) and serum prostate-specific antigen (PSA) measurement prior to surgery. 46 patients were found to have a carcinoma at histological examination of the surgical specimens. 14 carcinomas were detected preoperatively by TRUS and biopsy (10 pT1, 3 pT2, 1 pT3) of 32 patients with suspicious, i.e., hypoechoic, lesions at TRUS. Among the remaining 256 patients with normal findings at TRUS, another 32 carcinomas were found at histological examination of the surgical specimen. Of the 14 carcinomas detected by TRUS, 13 were found within a group of 57 patients with PSA levels > 7 ng/ml corresponding to a cancer detection rate of 22.8% in this group. In 231 patients with PSA < 7 ng/ml, the use of TRUS was successful in detecting only 1 carcinoma (cancer detection rate 0.4%). These results suggest that the use of TRUS is dispensible in 80% of palpably normal patients without affecting the cancer detection rate.

Aged↗

PubMed1992

The role of digital rectal examination, transrectal ultrasound, and prostate specific antigen for the detection of confined and clinically relevant prostate cancer.

In a study population, can digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA) (monoclonal) effectively detect the majority of clinically relevant cancer? If this is possible, the remaining patients could then be considered for chemopreventive protocols. The American Cancer Society/National Prostate Cancer Detection Project (ACS/NPCDP) had a cancer detection rate of 2.4% for its initial year utilizing PSA, DRE and TRUS. TRUS and PSA detected 73% more cancer than DRE alone. TRUS detected a greater percentage of cancers than DRE (85% vs. 64%). PSA was > or = 4 ng/ml for 66% of prostate cancer patients; 11% of cancer patients had PSA < 2 ng/ml. PSA decision levels based on gland volume detected a subgroup at the 95th percentile that had a nine-fold increased risk for cancer. In a separate study differentiating benign prostatic hypertrophy (BPH) and cancer, we found 0.12 +/- 0.13 ng/ml/gm for serum PSA (sPSA)/gm BPH. This study proved that predicted PSA (pPSA) = gland volume x 0.12; this equation also functioned at the 95th percentile for any individual patient. Individual patient assessment: 1. Entry level PSA = 2 ng/ml. 2. Those patients with PSA > 2 ng/ml have TRUS determination of gland volume (performed by technician). 3. pPSA = gland volume x 0.12. If sPSA > pPSA then: 4. (sPSA-pPSA)/2 = predicted volume (cc) of cancer; 5. 3 square root of volume of cancer = mean diameter (cm) of cancer. Thus, these results should detect the majority of clinically relevant cancer (> 0.5 cc). PSA combined with TRUS and DRE can identify high risk groups for cancer.

Humans↗

PubMed1999

Use of percentage of free prostate-specific antigen to identify men at high risk of prostate cancer when PSA levels are 2.51 to 4 ng/mL and digital rectal examination is not suspicious for prostate cancer: an alternative model.

OBJECTIVES: Currently, many clinicians do not recommend prostate biopsy for men with digital rectal examination (DRE) results that are not suspicious for cancer and prostate-specific antigen (PSA) values between 2.51 and 4 ng/mL. We propose a new model for the detection of prostate cancer using the percentage of free PSA (%FPSA) in the limited range of PSA values between 2.51 and 4 ng/mL that maximizes clinical specificity (ie, minimizes false-positive results). This model identifies higher risk patients in this relatively low-risk population. METHODS: Three hundred sixty-eight archived serum samples from men evaluated and treated at two academic institutions were reviewed. All men had a histologic diagnosis, findings not suspicious for cancer on DRE, and PSA levels between 2.51 and 4 ng/mL. Samples were tested in Hybritech's Tandem-R PSA and Tandem-R free PSA (FPSA) assays in the same laboratory at each institution. RESULTS: Various models for cancer detection using %FPSA when PSA is 2.51 to 4 ng/mL and DRE is not suspicious for cancer are proposed. These models recommend biopsy for only 10% to 36% of the men in this population and would identify as many as 30% to 54% of the detectable cancers. There is evidence that the cancers that would be detected are the most aggressive cancers in this population. CONCLUSIONS: Our models identified men with a higher risk of prostate cancer in a relatively low-risk population that currently does not routinely undergo biopsy. This may allow for a more cost-effective way to increase cancer detection when PSA values are between 2.51 and 4 ng/mL and DRE is not suspicious for cancer. This model has the potential to detect a greater number of clinically important and potentially curable cancers than would be detected with current practice.

Aged↗

PubMed2005

Accuracy of prostate weight estimation by digital rectal examination versus transrectal ultrasonography.

PURPOSE: The ability to estimate prostate weight is useful. Two commonly used methods for estimating prostate weight are digital rectal examination (DRE) and transrectal ultrasonography (TRUS). We evaluated the relative accuracy of these weight estimates by comparing them to prostate weight following radical retropubic prostatectomy (RRP). MATERIALS AND METHODS: Between 1989 and 2001 more than 36,000 community men participated in a large prostate cancer screening study. Of these men 2,238 underwent RRP. In this subset we examined the correlation between documented preoperative DRE and TRUS estimates of prostate weight with actual gland weight. RESULTS: DRE estimates of prostate weight by multiple examiners correlated poorly with RRP specimen weight (r = 0.2743). However, TRUS estimates correlated moderately well (r = 0.6493). TRUS provided more accurate estimates of prostate weight for smaller glands, although it generally underestimated gland weight compared to the weight of the surgical specimen. CONCLUSIONS: In a large, community based prostate cancer screening study prostate weight estimated by DRE was shown to correlate poorly with actual prostate weight. Compared with DRE, TRUS provides a better estimate of prostate weight. In addition, TRUS measurements were more accurate in smaller prostate glands.

Humans↗

PubMedDate not supplied

Meta-analysis of prostate-specific antigen and digital rectal examination as screening tests for prostate carcinoma.

BACKGROUND: Physicians commonly screen for prostate cancer by using prostate-specific antigen (PSA) and digital rectal examination (DRE). The usefulness of these screening mechanisms is not well established, however. A meta-analysis of PSA and DRE to detect prostate carcinoma was conducted with a focus on sensitivity, specificity, and positive predictive value. METHODS: A literature search of OVID database (1966 to November 1999) using the medical subject headings "prostate-specific antigen" and "mass screening," as well as "prostate carcinoma," was performed. Thirteen articles were selected for the meta-analysis in this study. Most studies included asymptomatic men older than 50 years from various countries. Pooled results were calculated from the individual reports for sensitivity, specificity, and positive predictive value for PSA and DRE based on biopsy result as the reference standard. RESULTS: The overall detection rate of prostate carcinoma was 1.8% based on a positive biopsy. Of the prostate carcinoma detected, 83.4% was localized. The pooled sensitivity, specificity, and positive predictive value for PSA were 72.1%, 93.2% and 25.1%, respectively; and for DRE were 53.2%, 83.6% and 17.8%, respectively. CONCLUSIONS: There were two major outcomes of this meta-analysis. One was the potential for detecting early-stage prostate cancer with these screening tests, because 83.4% of total cancers detected were localized. The second important outcome was that the overall sensitivity, specificity, and positive predictive value for PSA were higher than those for DRE when used as a screening tool to detect prostate cancer. When a patient has abnormal findings using PSA and DRE, the chance of cancer is 1 in 4 or 5. Conversely, when findings from PSA and DRE are normal, the chance of missing a cancer is about 10%.

Adult↗

PubMed2000

The risks of prostate cancer detection by transrectal ultrasound guide biopsy in Thai men with abnormal prostatic-specific antigen or abnormal digital rectal examination.

OBJECTIVE: To determine the risks of prostate cancer detection in Thai men with abnormal prostatic-specific antigen (PSA) or abnormal digital rectal examination (DRE). MATERIAL AND METHOD: One hundred and forty four Thai men with abnormal PSA or abnormal DRE or both were biopsied at the prostate gland with the use of transrectal ultrasound guide biopsy (TRUSBX). The risks of prostate cancer detection were evaluated. RESULTS: Mean age was 65.7 years old (S.D. = 9.88). The risks of positive biopsy according to the PSA levels of 0-4 ng/ml, 4.1-10 ng/ml, 10.1-20 ng/ml, 20.1-50 ng/ml, 50.1-100 ng/ml and more than 100 ng/ml were 6.25 per cent, 6.67 per cent, 10.8 per cent, 33.3 per cent, 60 per cent and 100 per cent, respectively. The risks of positive biopsy according to DRE appearances of total hard consistency, nodule, induration and benign prostatic hyperplasia were 57.1 per cent, 23.5 per cent, 34.6 per cent and 10 per cent, respectively. Of 144 men, 32 had adenocarcinoma of prostate. Radical prostatectomy was performed on 15 patients with clinically localized disease. Ten patients (66.6%) had free margin on their pathological specimens and 6 (40%) had organ confined disease. CONCLUSION: PSA testing alone or DRE alone is not a perfect test to diagnose prostate cancer since prostate cancer may present in men with normal PSA or men with no suspicious cancer DRE. For early detection of prostate cancer, both PSA testing and DRE need to be performed. When either PSA testing or DRE or both is abnormal, TRUSBX should be carried out.

Adenocarcinoma↗

PubMed1999

Efficiency of prostate-specific antigen and digital rectal examination in screening, using 4.0 ng/ml and age-specific reference range as a cutoff for abnormal values.

BACKGROUND: The purpose of this study was to examine the diagnostic efficiency of prostate-specific antigen (PSA) and digital rectal examination (DRE) testing when using either 4.0 ng/ml or an age-specific reference range (ASRR) as an abnormal cutoff PSA value. METHODS: Between 1992-1995, 116,073 men, aged 40-79 years, were screened during Prostate Cancer Awareness Week. When using a 4.0-ng/ml cutoff PSA value, 22,014 had either an abnormal PSA, an abnormal DRE, or both. When using an ASRR cutoff PSA value, 17,561 had either an abnormal PSA, an abnormal DRE, or both. The positive predictive value (PPV), sensitivity, and specificity of PSA, DRE, and combined PSA and DRE tests were evaluated. RESULTS: When using a 4.0-ng/ml cutoff PSA value, the PPVs of abnormal PSA alone, abnormal DRE alone, and combined abnormal PSA and DRE tests were 27.7%, 17.7%, and 56.0%, respectively. Sensitivities were 34.9%, 27.1%, and 38.0%, respectively. Specificities were 63.1%, 49.0%, and 87.9%, respectively. When using an ASRR cutoff PSA value, the PPVs of each category were 31.8%, 20.8%, and 63.7%, respectively. Sensitivities were 27.1%, 41.0%, and 31.8%, respectively. Specificities were 75.0%, 32.8%, and 92.2%, respectively. The PPVs of the PSA test were higher than those of the DRE. The PPVs of combined tests were highest when using either a 4.0-ng/ml cutoff PSA value or an ASRR cutoff PSA value (all P < 0.001). When using an ASRR, the PPVs of PSA, DRE, and combined tests were higher than those when using a 4.0-ng/ml without statistical significance (all P > 0.05). Sensitivity of PSA when using an ASRR was lower than when using 4.0 ng/ml. CONCLUSIONS: Significantly higher PPVs indicated that utilizing both a PSA test and a DRE is most effective in screening for the early detection of prostate cancer. Although higher PPVs when using an ASRR cutoff PSA value suggested fewer unnecessary biopsies, lower sensitivities resulted in fewer cancers detected. Thus, we recommend that the combination of a PSA test with a cutoff value of 4.0 ng/ml and a DRE should continue to be utilized in the screening programs.

Adult↗

PubMed2001

Diagnostic significance of digital rectal examination and transrectal ultrasonography in men with prostate-specific antigen levels of 4 NG/ML or less.

OBJECTIVES: To investigate the usefulness of digital rectal examination (DRE) and transrectal ultrasonography (TRUS) for prostate cancer diagnosis and to propose a diagnostic algorithm for individual-based cancer screening in subjects with prostate-specific antigen (PSA) levels of 4.0 ng/mL or less. METHODS: Between January 1992 and March 2000, 129 subjects with PSA levels of 4.0 or less and abnormal findings on DRE or TRUS underwent prostate biopsy. The subjects were divided into four groups according to the PSA range: 0 to 0.9 ng/mL, 1.0 to 1.9 ng/mL, 2.0 to 2.9 ng/mL, and 3.0 to 4.0 ng/mL. The reliability of the DRE and TRUS and the clinicopathologic features of prostate cancer were investigated among these four groups. RESULTS: Of the 129 subjects, 17 (13.2%) patients with prostate cancer were diagnosed. The detection rate was 2.2% (1 of 45), 0% (0 of 27), 20.6% (7 of 34), and 39.1% (9 of 23) in subjects with PSA levels of less than 1.0 ng/mL, 1.0 to 1.9 ng/mL, 2.0 to 2.9 ng/mL, and 3.0 to 4.0 ng/mL, respectively. The proportion of patients with Stage II, III, and IV was 58.8%, 41.2%, and 0%, respectively. The percentage with Gleason scores of 8 to 10 was 17.6%. The detection rate of abnormal findings on DRE and TRUS was 14.4% (13 of 90) and 9.5% (7 of 74), respectively. Adding TRUS to DRE in the screening program of subjects with PSA levels of 2.0 to 4.0 ng/mL, increased the detection rate of prostate cancer to 30.8% (4 of 13). CONCLUSIONS: Routine prostate biopsy should not be undertaken except for highly suspicious DRE findings in subjects with PSA levels less than 2.0 ng/mL. The additional use of TRUS in subjects with PSA levels of 2.0 to 4.0 ng/mL would improve the sensitivity of prostate cancer detection. The diagnostic algorithm proposed in the present study is useful as a screening method for prostate cancer in subjects with PSA levels of 4.0 ng/mL or less.

Adult↗

PubMed1994

The effect of transrectal ultrasonography (TRUS) including digital rectal examination (DRE) of the prostate on the level of prostate specific antigen (PSA).

OBJECTIVE: To study the effect of transrectal ultrasonography (TRUS) including digital rectal examination (DRE) of the prostate on serum prostate specific antigen (PSA). PATIENTS AND METHODS: In a diagnostic centre for general practitioners serum PSA was determined in patients before, immediately after, and one week after TRUS including DRE. In a small group of patients PSA was determined at various times after DRE and TRUS. RESULTS: The PSA levels showed a statistically significant rise of 20% immediately after DRE and TRUS. After 7 days the PSA levels had returned to their initial levels. This decrease appeared to occur within the first 24 h. CONCLUSION: When applying the diagnostic triad PSA, DRE and TRUS blood samples for PSA should preferably be taken before DRE and TRUS. If blood samples are taken afterwards, it is safe to do so after seven days.

Adult↗

PubMedDate not supplied

Digital rectal examination (DRE) does not influence total serum levels of prostate specific antigen (tPSA), in individuals without prostate pathology.

OBJECTIVE: To evaluate if the digital rectal examination (DRE) performed before determination of total serum prostate specific antigen (tPSA) influences the levels of this protein. MATERIALS AND METHODS: Forty-eight men without a diagnosis of prostate pathology were assessed for tPSA levels, before and 30 minutes after DRE examination. Values of tPSA in the individuals' serum were measured by the electrochemoluminescence (ECLIA), in Roche's Elecys 1010 analyzer. RESULTS: DRE examination induced a modest elevation in tPSA values in 34 of the 48 men, with a variation in mean elevation from 2.19% in the age range >/= 70 years to 11.96% in the age range of 60-69 years. Additionally, moderate decreases in values were detected in 11 individuals and 3 did not present any alteration following the procedure. Differences in mean values of tPSA, pre- and post-DRE were not statistically significant, neither in the total sample of individuals or in the age range groups. CONCLUSION: DRE examination does not significantly influence the tPSA values in individuals under study.

Journal Article↗

PubMedDate not supplied

Methods of early detection of prostate cancer: the role of prostatic specific antigen, transrectal ultrasound and digital rectal examination.

PSA has significantly influenced the management of prostate cancer. Early detection of clinically significant cancer has been increased by combining PSA and digital rectal examination. PSA has been used as a prognostic factor for patients with local disease and as a monitoring test for patients undergoing curative therapy for localized prostate cancer.

Aging↗

PubMed2005

Resectability of rectal cancers still fixed after radio-chemotherapy: evaluation by digital rectal examination, MRI, and intraoperative examination.

Eighteen patients with primary fixed rectal cancer as judged by digital rectal examination (DRE) were included. They all had radiation therapy with 60 Gy in 30 fractions combined with oral UFT and Isovorin. All patients were evaluated by DRE and magnetic resonance imaging (MRI) before and after treatment. After 5-7 weeks, eight tumors were mobile on DRE. All eight patients had an R0 resection. Of the remaining ten patients with fixed rectal cancer, eight had an R0 resection. One patient had an R1 resection and one patient was not operated. Intraoperative bimanual rectal examination was performed with one finger through the anus and one hand in the rectovaginal/rectovesical fossa before resection was performed. After chemo-radiation DRE correctly predicted the tumor to be advanced or not in 12/17 patients, MRI in 14/17, and bimanual rectal examination in 17/17 patients.

Adenocarcinoma↗

PubMed1993

Biopsy-proved prostate cancer in 100 consecutive men with benign digital rectal examination and elevated serum prostate-specific antigen level. Prevalence and pathologic characteristics.

To determine whether a significant percentage of patients with a benign digital rectal examination (DRE) and an elevated serum prostate-specific antigen (PSA) level harbor a prostatic malignancy, 100 consecutive patients underwent transrectal ultrasound (TRUS)-guided biopsy of the prostate. The biopsy results were correlated with the pre-biopsy serum PSA level and ultrasound findings. Overall, the cancer detection rate was 35 percent (S.E. 4.8%). When the biopsy results were analyzed according to the PSA level, the rate of cancer detection increased with advancing PSA levels, irrespective of ultrasound findings. In the 60 patients with ultrasound abnormalities, the cancer detection rate was 47 percent compared with 18 percent for those without ultrasound abnormalities. Comparison of TRUS-negative and TRUS-positive biopsy results revealed a more than two-fold increase in cancer detection for the TRUS-positive group in each PSA range. Cancer detection in the TRUS-positive, PSA 4.1-10, 10.1-20.0, and > 20 ng/mL groups was 40 percent, 56 percent, and 67 percent, respectively; in the TRUS-negative group, cancer detection was 12 percent, 27 percent, and 33 percent, respectively. Twenty (57%) of the patients with prostate cancer underwent radical retropubic prostatectomy. The mean tumor volume was 4.7 cc. Seventy percent had organ-confined disease, 30 percent demonstrated capsular penetration only, and no patients had seminal vesicle or pelvic lymph node invasion. These data indicate that a significant percentage of patients with a benign DRE and an elevated serum PSA value harbor a clinically significant, but potentially curable prostatic malignancy.

Adenocarcinoma↗