title: Utility of digital rectal examination, serum prostate specific antigen, and transrectal ultrasound in the detection of prostate cancer: a developing country perspective.
abstract: OBJECTIVE
  To determine the utility of digital rectal examination (DRE), serum total prostate specific antigen (tPSA) estimation, and transrectal ultrasound (TRUS) for the detection of prostate cancer (PCa) in men with lower urinary tract symptoms (LUTS).
  
  
  METHODS
  All patients with abnormal DRE, TRUS, or serum tPSA >4ng/ml, in any combination, underwent TRUS-guided needle biopsy. Eight cores of prostatic tissue were obtained from different areas of the peripheral prostate and examined histopathologically for the nature of the pathology.
  
  
  RESULTS
  PCa was detected in 151 (50.3%) patients, remaining 149 (49.7%) showed benign changes with or without active prostatitis. PCa was detected in 13 (56.5%), 9 (19.1%), 26 (28.3%), and 103 (74.6%) of patients with tPSA <4 ng/ml, 4-10 ng/ml, 10-20 ng/ml and >20 ng/ml respectively. Only 13 patients with PCa had abnormal DRE and TRUS with serum PSA <4 ng/ml. The detection rate was highest in patients with tPSA >20 ng/ml. The association between tPSA level and cancer detection was statistically significant (p<0.01). Among 209 patients with abnormal DRE and raised serum PSA, PCa was detected in 128 (61.2%).
  
  
  CONCLUSIONS
  The incidence of PCa increases with increasing serum level of tPSA. The overall screening and detection rate can be further improved by using DRE, TRUS and TRUS-guided prostate needle biopsies.
authors.affiliation: Departments of Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan E-mail : drmubaraksiut@yahoo.com.
authors.forename: Deep Par
authors.initials: DP
authors.lastname: Kash
authors.forename: Murli
authors.initials: M
authors.lastname: Lal
authors.forename: Altaf Hussain
authors.initials: AH
authors.lastname: Hashmi
authors.forename: Muhammed
authors.initials: M
authors.lastname: Mubarak
mesh_terms: D000368:Aged; D003906:Developing Countries; D051517:Digital Rectal Examination; D055088:Early Detection of Cancer; D006801:Humans; D061705:Image-Guided Biopsy; D059411:Lower Urinary Tract Symptoms; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D036761:Ultrasound, High-Intensity Focused, Transrectal
chemical_list: D017430:Prostate-Specific Antigen