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.
Simak
R
R
Department of Urology, University of Vienna Medical School, Austria.
Eisenmenger
M
M
Hainz
A
A
Kratzik
C
C
Marberger
M
M
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D010173:Palpation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging*; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D017430:Prostate-Specific Antigen