Relative contribution of digital rectal examination and transrectal ultrasonography in interpreting serum prostate-specific antigen values for screening prostate cancer in Arab men.
BACKGROUND
This study was conducted to determine the utility of digital rectal examination (DRE), transrectal ultrasonography (TRUS) and serum prostate-specific antigen (PSA) in the diagnosis of prostate cancer in men in Arabia, an are of the world with a relatively low incidence of this disease.


METHODS
329 patients suspected of having prostate cancer on account of raised serum PSA level (>4 ng/ml), DRE or TRUS findings, underwent TRUS-guided prostate biopsy. Raised PSA individually as well as combined, or a lesion suspicious of carcinoma on DRE or TRUS was recorded as PSA(+), DRE(+) or TRUS(+), respectively. The contribution of DRE, TRUS and serum PSA to the diagnosis of prostate cancer was analysed.


RESULTS
Of the 329 patients who had prostate biopsies 109 cases (33.1%) had PCa. Of these 109 patients 56 (51%) had DRE(+), 77 (42%) had TRUS(+) and 49 (66%) had both DRE(+) and TRUS(+). Statistical analysis revealed that DRE(+) tripled the probability for cancer. PSA over a range of 10-50 ng/mL demonstrated an increasing cancer probability ranging from 2 to 3 fold. TRUS(+) was only significantly associated with cancer risk if PSA was elevated. The presence of all three factors increased the cancer probability by 6 to 7 fold.


CONCLUSIONS
TRUS findings are dependent on PSA for interpretation while DRE(+) with elevated PSA makes PCa more likely.
Sheikh
Mehraj
M
Department of Radiology, Faculty of Medicine, Kuwait University P.O. Box 24923, Safat, 13110 Kuwait. mehraj@hsc.edu.kw
Sinan
Tariq
T
Kehinde
Elijah O
EO
Hussein
Ali Yt
AY
Anim
Jehoram T
JT
Al-Hunayan
Adel A
AA
D000368:Aged; D018912:Arabs; D051517:Digital Rectal Examination; D006801:Humans; D008297:Male; D008403:Mass Screening; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D014463:Ultrasonography
D017430:Prostate-Specific Antigen