Prostate cancer risk assessment program: a 10-year update of cancer detection

PURPOSE: Guidelines for screening men at high risk for prostate cancer remain under investigation. We report our 10-year cancer detection data from the Prostate Cancer Risk Assessment Program, a longitudinal screening program for men at high risk. MATERIALS AND METHODS: Men between ages 35 and 69 years with a family history of prostate cancer, any black man regardless of family history or any patient with a known mutation in the BRCA 1 gene are eligible for the Prostate Cancer Risk Assessment Program and undergo longitudinal followup. Cancer detection, prostate cancer features and the predictive value of screening parameters were determined based on Prostate Cancer Risk Assessment Program biopsy criteria. RESULTS: A total of 609 men were accrued to the Prostate Cancer Risk Assessment Program as of the end of June 2006, of whom 61.2% were black. Of all participants 19% underwent prostate biopsies. The prostate cancer incidence was 9.0%, more than 90% of prostate cancers were Gleason score 6 or higher and 22% were Gleason score 7 or higher. The majority were organ confined. Of men diagnosed with prostate cancer 20% had a prostate specific antigen of less than 2.5 ng/ml and a free prostate specific antigen of less than 25% with a normal digital rectal examination. CONCLUSIONS: Our results support aggressive screening measures for men at high risk for prostate cancer. The majority of cancers detected were at a prostate specific antigen of less than 4.0 ng/ml with a fifth diagnosed at a prostate specific antigen of below 2.5 ng/ml. These cancers were intermediate to high grade and organ confined, indicating a greater likelihood of cure following local therapy in these men.     

Family history of prostate cancer and obesity in relation to high-grade disease and extraprostatic extension in young men with prostate cancer

BACKGROUND: Little is known about predictors of prostate cancer severity in young men. Therefore, we examined whether family history and obesity influence risk of high-grade disease and extraprostatic extension in men < 55-years old. METHODS: Four hundred ninety-eight men aged < 55 years who had had a radical prostatectomy (1992-1999) by one surgeon were mailed a survey in 2000 to assess family history of PCa and anthropometrics. Body mass index (BMI = kg/m(2)) was calculated as an indicator of obesity. Logistic regression was used to compute odds ratios (OR) for high-grade disease (Gleason score > or = 7) and extraprostatic extension. RESULTS: Of the 363 respondents, 35.8% had at least one first-degree relative with PCa. Men with a family history were younger at surgery than those without a family history (48.8 vs. 50.1 years, P < 0.001). After controlling for age, cigarette smoking, and race/ethnicity, men with an affected father had a lower risk of high-grade disease compared to those without an affected father (OR = 0.42, 95% CI 0.23-0.76). Risk of high-grade disease increased with increasing BMI, especially in men < 50-years old (P-trend = 0.02). Family history and BMI were not clearly associated with extraprostatic extension. CONCLUSIONS: After taking into account a younger age at presentation among men with a family history, young men with a family history of PCa were less likely to have high-grade disease. Obesity may be associated with a poorer histology in young men with PCa, especially in men younger than 50 years of age.     

Role of family history and ethnicity on the mode and age of prostate cancer presentation

BACKGROUND: This study was conducted to investigate the role of family history of prostate cancer and ethnic variation on age at diagnosis and the mode of prostate cancer presentation among a multiracial cohort of men in the Bronx and on Long Island. METHODS: A retrospective hospital-based study of 953 men (62% white, 24% African-American, 9% Hispanic, and 5% other ethnicities) with biopsy-confirmed prostate cancer diagnosed between 1991 and 1996. Data were collected between 1996 and 1998 using self-administered questionnaires that assessed age at diagnosis, ethnicity, family history of prostate cancer, and first indication of potential prostate cancer. RESULTS: Men with a family history of prostate cancer were diagnosed at an earlier mean age than those who lacked a family history (P<0.001). Prostate cancer patients with an affected father had a significantly lower mean age at diagnosis than those patients who indicated that at least one brother (but not their father) was affected (P<0.001). African-Americans reported a family history of prostate cancer more often than whites (P<0.01) and were younger at diagnosis (P<0.0001). Hispanic patients were less likely to be identified by screening and more likely to present with symptoms compared with whites (P<0.0001) and African-Americans (P<0.001). CONCLUSIONS: Men with an affected father were more likely to have disease diagnosed at an early age. The lower rates of presentation by prostate cancer screening of Hispanic men with prostate cancer suggests that increased surveillance may be warranted in this population.     

Decreasing age at prostate cancer diagnosis over successive generations in prostate cancer families

BACKGROUND: The decline in age at prostate cancer diagnosis over the past decade is partially attributable to prostate specific antigen (PSA) screening. We examined age at diagnosis over successive generations within prostate cancer families. METHODS: Families with at least two affected men were selected from the University of Michigan Prostate Cancer Genetics Project. The 1,345 individuals from 489 families were grouped into three generations. RESULTS: Risk of prostate cancer diagnosis at a given age was estimated to increase 1.31 (95% CI: 1.13-1.51) times from one generation to the next. Among men diagnosed prior to the PSA era, inferences were similar (hazard ratio = 1.28, 95% CI: 0.97-1.68). No maternal versus paternal disease transmission effect was observed. CONCLUSIONS: Age at prostate cancer diagnosis was observed to decrease over successive generations in families from an ongoing familial prostate cancer study. This finding, if confirmed, may have important implications for familial prostate cancer risk assessment.     

Clinical characteristics of African-American men with hereditary prostate cancer: the AAHPC Study

INTRODUCTION: The African-American Hereditary Prostate Cancer (AAHPC) Study was designed to recruit African-American families fulfilling very stringent criteria of four or more members diagnosed with prostate cancer at a combined age at diagnosis of 65 years or less. This report describes the clinical characteristics of a sample of affected AAHPC family members. METHODS: In all, 92 African-American families were recruited into the study between 1998 and 2002. Complete clinical data including age and PSA at diagnosis, number of affected per family, stage, grade, and primary treatment were available on 154 affected males. Nonparametric Wilcoxon two-sample tests and Fisher's exact test (two-tailed), were performed to compare families with 4-6 and >6 affected males with respect to clinical characteristics. RESULTS: The mean number of affected men per family was 5.5, with a mean age at diagnosis of 61.0 (+/-8.4) years. Age at diagnosis, PSA and Gleason score did not show significant differences between the two groups of families. Based on the Gleason score, 77.2% of affected males had favorable histology. Significantly, there were marked differences between the two groups in the frequency of node-positive disease (P=0.01) and distant metastases (P=0.0001). Radical prostatectomy was the preferred primary therapy for 66.2% of all affected men followed by 20.8% who chose radiation therapy. CONCLUSIONS: Our findings suggest that affected males who carry the highest load of genetic factors are at the highest risk for early dissemination of disease, thus efforts at early diagnosis and aggressive therapeutic approaches may be warranted in these families. Since the primary therapy choices in our study favored definitive treatment (87.0%) when compared to the 1983 and 1995 SEER data in which 28 and 64% received definitive treatment, respectively, it appears that affected African-American men in multiplex families may be demonstrating the reported psycho-social impact of family history on screening practices and treatment decisions for prostate cancer.     

Screening for prostate cancer in high risk populations

PURPOSE: Black men and men with a family history of prostate cancer are at higher risk for this disease and may have an earlier age of onset. Consequently, screening at a younger age has been recommended for high risk men, however, there are limited data on actual screening results in young, high risk populations. MATERIALS AND METHODS: In men 50 years old or older we compared screening results in 1,224 black men, 1,227 men with a positive family history and 63 men who were both with those of 15,964 nonblack men with no known family history. In high risk men in their forties we also evaluated the percent with abnormal screening tests, the positive predictive value of screening tests, cancer detection rates and the prognostic features of tumors detected. RESULTS: In men 50 years old or older prostate cancer detection rates were 6.4% for controls compared with 10.3%, 10.5% and 17.5%, respectively, for the high risk groups. Among high risk men screened in their forties 8% had suspicious screening tests and approximately 55% who underwent a biopsy had cancer detected. Of tumors detected 80% were organ confined and all but 1 were of moderate Gleason grade 5 years old or older. Only 1 tumor (7%) fulfilled the published criteria for a possibly harmless cancer. CONCLUSIONS: Black men and men with a family history of prostate cancer are at a 75% to 80% higher risk for prostate cancer. On initial screening of high risk men in their fourth decade only 8% have positive screening tests; however, approximately 55% of these men have tumors, most of which are medically important with favorable prognostic features.     

Evaluation of the Prostate Cancer Prevention Trial Risk calculator in a high‐risk screening population

Study Type – Diagnostic (exploratory cohort)
Level of Evidence 2b

OBJECTIVE

To evaluate the Prostate Cancer Prevention Trial (PCPT) risk calculator in a screening cohort of young, racially diverse, high‐risk men with a low baseline prostate‐specific antigen (PSA) level and enrolled in the Prostate Cancer Risk Assessment Program (PRAP). The PCPT calculator provides an assessment of prostate cancer risk based on age, PSA level, race, previous biopsy, and family history.

PATIENTS AND METHODS

Eligibility for PRAP includes men aged 35–69 years who are African‐American, have a family history of prostate cancer, or have a known BRCA1/2 mutation. PCPT risk scores were determined for PRAP participants, and were compared to observed prostate cancer rates.

RESULTS

In all, 624 participants were evaluated, including 382 (61.2%) African‐American men and 242 (38.7%) men with a family history of prostate cancer; the median (range) age was 49.0 (34.0–69.0) years and the median PSA level 0.9 (0.1–27.2) ng/mL. The PCPT risk score correlated with prostate cancer diagnosis, as the median baseline risk score in patients diagnosed with prostate cancer was 31.3%, vs 14.2% in patients not diagnosed with prostate cancer (P < 0.001). The PCPT calculator similarly stratified the risk of diagnosis of Gleason score ≥7 disease, as the median risk score was 36.2% in patients diagnosed with Gleason ≥7 prostate cancer vs 15.2% in all other participants (P < 0.001).

CONCLUSION

The PCPT risk calculator score was found to stratify prostate cancer risk in a cohort of young, primarily African‐American men with a low baseline PSA level. These results support further evaluation of this predictive tool for assessing the risk of prostate cancer in high‐risk men.     

Finasteride improves the sensitivity of digital rectal examination for prostate cancer detection

PURPOSE: Men undergoing screening for prostate cancer are recommended to undergo digital rectal examination and prostate specific antigen measurement. We previously presented data from the Prostate Cancer Prevention Trial indicating that finasteride improves the performance characteristics of prostate specific antigen for cancer detection. In the current study we report the impact of finasteride on digital rectal examination sensitivity and specificity. MATERIALS AND METHODS: We examined the sensitivity and specificity of digital rectal examination in Prostate Cancer Prevention Trial subjects receiving finasteride or placebo who underwent prostate biopsy, had prostate specific antigen measurement and digital rectal examination within 1 year before biopsy and were on treatment at biopsy. RESULTS: Of 9,423 men in the finasteride group 4,579 and 5,112 of 9,459 in the placebo group met study evaluation requirements. Of 4,579 men in the finasteride group 695, including 264 with Gleason 7 or greater and 81 with Gleason 8 or greater, and 1,111 of 5,112 in the placebo group, including 240 with Gleason 7 or greater and 55 with Gleason 8 or greater, were diagnosed with prostate cancer. In men in the placebo and finasteride groups digital rectal examination sensitivity was greater for detecting higher grade tumors. The sensitivity of digital rectal examination was significantly greater for cancer detection in men receiving finasteride than placebo (21.3% vs 16.7%, p=0.015). Digital rectal examination sensitivity was also greater for detecting high grade (Gleason 7 or greater and 8 or greater) cancers in men receiving finasteride but this did not attain statistical significance. Digital rectal examination specificity was similar in men receiving finasteride or placebo. CONCLUSIONS: Finasteride significantly improves prostate cancer detection with digital rectal examination.     

Current age and race adjusted prostate specific antigen threshold values delay diagnosis of high grade prostate cancer

PURPOSE: Age specific prostate specific antigen ranges have been advocated to increase the predictive value of prostate specific antigen based on increases that occur with aging. We suggest that prostate specific antigen is not a dichotomous biomarker and age specific reference ranges delays the diagnosis of high grade prostate cancer in older and black American men. MATERIALS AND METHODS: Using the Prostate Cancer Prevention Trial risk calculator we evaluated the impact of age on the risk of high grade prostate cancer in white and black men. We created a hypothetical population of men by standardizing risk variables, including negative family history, normal digital rectal examination and no history of negative biopsy. Results were compared in the 2 populations using 5-year age increments from ages 55 to 75 years and increasing prostate specific antigen. RESULTS: Increasing age was associated with a higher risk of high grade prostate cancer in white and black men. The risk of high grade prostate cancer in a black man was twice that in a white man with the same prostate specific antigen at all prostate specific antigen values. CONCLUSIONS: Age specific and race specific prostate specific antigen ranges are flawed. Many patients who would not be considered for biopsy based on these prostate specific antigen ranges are at significant risk for high grade prostate cancer. The risk of high grade prostate cancer in black men is twice that in white men. Risk assessment in black men and older men is necessary to diagnose high grade prostate cancer when treatment can be effective.     

Recruitment strategies and comparison of prostate cancer-specific clinical data on African-American and Caucasian males with and without family history

Prostate cancer is the most common cancer in men in the United States. This is a complex disease with high heterogeneity and the exact causes are unknown in population-specific samples. Family history is a primary risk factor irrespective of race. Identifying prostate cancer families with multiple affected cancer cases is challenging. Herein we document recruitment techniques and present prostate cancer clinical factors described in a cohort of African Americans and Caucasians with or without a strong family history. A total of 521 prostate cancer patients (241 African Americans and 280 Caucasians) were identified using a novel cooperative methodology involving a combination of treating physicians and tumor registries. Higher prostate-specific antigen (PSA, P=0.0269) was found in familial cases as compared to sporadic cases in African-American men. In addition, PSA values for familial cases were higher (P=0.0093) in African-American as compared to Caucasian men. No differences were detected in Gleason score values in either race, regardless of family history. These findings remained the same after adjustment was made for age at diagnosis. In conclusion, methodologies for cohort acquisition, and clinical characteristics, are described for men with and without a family history of prostate cancer using both Caucasian and African-American populations.     

Results of compliance with prostate cancer screening guidelines

PURPOSE: Current guidelines of the American Cancer Society and the National Comprehensive Cancer Network recommend offering annual prostate cancer screening with prostate specific antigen (PSA) and digital rectal examination (DRE) beginning at age 50 (age 45 in high risk men). There are limited data concerning outcomes if all men followed screening guidelines. We report early outcome data on men who entered a prostate cancer screening study, complied with the screening guidelines and were subsequently diagnosed with prostate cancer. MATERIALS AND METHODS: We reviewed records of men 45 to 59 years old at study entry with a PSA less than 2.6 ng/ml and benign DRE who underwent annual DRE and PSA testing in a screening study between 1991 and 2001. Of 10,174 men with these characteristics, 232 (2.3%) were subsequently diagnosed with prostate cancer. We evaluated PSA, Gleason score, clinical and pathological tumor stage, and treatment outcomes in these men. RESULTS: Median PSA at diagnosis was 3.1 ng/ml (range 0.4 to 9.6). Gleason scores ranged from 4 to 9. All patients had clinically localized disease. Management included predominantly radical prostatectomy (87%) and radiation therapy (10%). Of cancers in which tumor volume was assessed 13% were considered possibly harmless tumors by previously published criteria and 2% were considered possibly rapidly progressive tumors by criteria we set in this study. CONCLUSIONS: Prostate cancer screening using some current guidelines results in the detection of cancers that are organ confined in 79% of patients, possibly harmless in less than 15% and possibly rapidly progressive in 2%.     

Prospektive Evaluierung der Prostatakarzinomfrüherkennung bei Männern mit familiärer Disposition

BACKGROUND: Family history is one of the strongest risk factors for prostate cancer. In this prospective study we evaluated the results of prostate cancer screening performed in healthy brothers of prostate cancer patients. The detection rate of prostate cancer and the positive predictive value of the examinations were determined. MATERIAL AND METHODS: The study population comprised 513 healthy men who were 38-75 years of age (median 62.0 years). Of these men, 268 having only one affected brother with prostate cancer were assigned to the sporadic group, and 245 probands having 2-10 affected relatives were assigned to the familial group. An abnormal PSA and/or a pathological digital rectal examination (DRE) was noted in 17.5% of familial (43/245) and 15.8% of sporadic probands (35/268). A biopsy of the prostate was performed in 60.5% of familial (26/43) and 71.4% of sporadic (25/35) men with pathological findings. RESULTS: Prostate cancer was found in 15 of 26 familial (57.7%) and 16 of 25 sporadic (64.0%) probands by prostate biopsy. The overall detection rate was 6.0% (31/513). CONCLUSION: Due to an increased prevalence the detection rate of prostate cancer and the positive predictive value of PSA and/or DRE are higher in men with a family history as expected in an unselected population. Our data suggest that in predisposed men prostate cancer screening should be recommended early. Furthermore an early indication for prostate biopsy is necessary. This recommendation should also be applied if only one first-degree relative has prostate cancer.     

Assoziation von familiärem Status mit Histologie und klinischem Verlauf beim frühen Prostatakarzinom

BACKGROUND: In a large number of studies a positive family history is documented as one of the main risk factors for the development of prostate cancer. In a US population an association between early-onset prostate cancer among familial patients and a more differentiated tumour was shown. The aim of this study was to compare clinical parameters between sporadic and familial or hereditary patients with an age at diagnosis < or =55 years. MATERIAL AND METHODS: The clinical data of prostate cancer patients with an age at diagnosis < or =55 years and who were recruited between July 1999 and the end of June 2004 to the database "familial prostate cancer in Germany" were analysed. The following data were documented for all patients: PSA at diagnosis, histopathological stage, grading, Gleason score and progression-free survival. RESULTS: The clinical data of 685 patients could be completed: 222 (32.4%) had one first-degree relative with prostate cancer, 48 of whom (7.0%) were hereditary; 463 (67.6%) were sporadic. The median age at diagnosis in the hereditary patients was 51.6 (41-55) years, in the familial patients 51.1 (35-55) years and in the sporadic patients 52.0 (38-55) years. The median follow-up was 24 months in hereditary, 36 months in familial and 35 months in sporadic patients. An initial curative therapy with radical prostatectomy or radiotherapy/brachytherapy was planned in 657/685 (95.9%) of the patients. There were no clear differences regarding PSA at diagnosis, the postoperative parameters (organ-confined disease, lymph node involvement, Gleason score, grading) and the progression-free survival in sporadic and familial or hereditary patients. CONCLUSIONS: Patients with an age at diagnosis < or =55 years have a positive family history more often than all prostate cancer patients in Germany. No association could be shown between pathohistological stage or clinical course and a positive family history in patients with an age at diagnosis < or =55 years.     

Reported family history of cancer in 1,271 prostate cancer cases and 1,909 controls

Prostate cancer risk has been associated with a family history of the disease. A two- to three-fold increase in risk has been observed in several studies. Details concerning modification of this risk by age, type of familial history of prostate cancer, and possible involvement of history of cancer at other sites have been less well documented. This case-control study of 1,271 prostate cancer patients and 1,909 control subjects admitted to Roswell Park Cancer Institute in Buffalo, NY, found age-adjusted increased risk associated with reporting a history of prostate cancer in a father (RR = 2.3, 95% Cl 1.4−3.3) or brother (RR = 2.5, 95% Cl 1.6−3.9). Subjects with both a father and brother affected had a 6.5-fold (95% Cl 1.4–30.5) increased risk of prostate cancer. Greater risk were observed at younger ages of diagnosis. Risks associated with reporting a father or a brother affected were not significantly elevated for patients over age 70 at diagnosis. No significant differences in patients reporting histories of cancer other than prostate cancer were observed regardless of relationship, age at diagnosis, or type of cancer examined. These observations from a large cancer patient population may be useful when making recommendations for cost-effective prostate cancer screening and for directing investigators to the potentially most informative subjects.     

Prohibitin mutations are uncommon in prostate cancer families linked to chromosome 17q

BACKGROUND: Linkage studies have provided evidence for a prostate cancer susceptibility locus on chromosome 17q. The mitochondrial protein prohibitin (PHB) is a plausible candidate gene based on its chromosomal location (17q21) and known function. METHODS: All coding regions and intron/exon junctions of the PHB gene were sequenced in 32 men from families participating in the University of Michigan Prostate Cancer Genetics Project that demonstrated evidence of linkage to 17q markers. RESULTS: Although a number of nucleotide variants were identified, no coding region substitutions were identified in any of the 32 men with prostate cancer from 32 unrelated multiplex prostate cancer families. CONCLUSIONS: PHB mutations do not appear to account for the linkage signal on 17q21-22 detected in PCGP families. Fine mapping of this region is in progress to refine the candidate region and highlight additional candidate prostate cancer susceptibility genes for sequence analysis.     

Prostate cancer in patients with screening serum prostate specific antigen values less than 4.0 ng/dl: results from the cooperative prostate cancer tissue resource

PURPOSE: Prostate cancer can occur in patients with low screening serum prostate specific antigen (PSA) values (less than 4.0 ng/ml). It is currently unclear whether these tumors are different from prostate cancer in patients with high PSA levels (greater than 4.0 ng/ml). MATERIALS AND METHODS: From the Cooperative Prostate Cancer Tissue Resource database through March 2004, 3,416 patients with screening PSA less than 16.0 ng/ml diagnosed with prostate cancer between 1993 and 2004 were stratified in groups based on screening serum PSA. These subsets were compared for race, age at diagnosis, clinical and pathological stage, Gleason score, positive surgical margins, posttreatment recurrent disease, and vital status. RESULTS: We identified 468 (14%) patients with screening PSA less than 4.0 ng/ml, 142 (4.2%) of whom had a PSA of less than 2.0 ng/ml. This group included 40 black and 376 white patients. Men with low screening PSA treated with radical prostatectomy had smaller cancers, lower Gleason scores, lower pathological tumor (T) stage and lower PSA recurrence rates than men with high PSA levels (4 ng/ml or greater). These differences held true for men who were younger than 62 years or were white, whereas older or black men had tumor characteristics and outcomes similar to those with higher PSA levels. CONCLUSIONS: Young (younger than 62 years) or white patients with screening serum PSA less than 4.0 ng/ml had smaller, lower grade tumors and lower recurrence rates than patients with PSA 4.0 ng/ml or greater. This was not true for those older than 62 years and for black men.     

R726L androgen receptor mutation is uncommon in prostate cancer families in the united states

BACKGROUND: A mutation in the androgen receptor (AR) gene, namely AR R726L, was described in 2% of Finnish men with sporadic or familial prostate cancer and was associated with an approximately sixfold increased risk of prostate cancer. We set out to determine the incidence of this mutation in a sample of men with either early-onset and/or familial prostate cancer in the United States. METHODS: Five hundred forty-eight men with prostate cancer from 411 unrelated families participating in the University of Michigan Prostate Cancer Genetics Project (PCGP) were studied. Allele-specific oligonucleotide hybridization was used to detect the presence of the AR R726L mutation in germline DNA. RESULTS: None of the 548 prostate cancer patients studied, including 513 White, 29 African American, 3 Asian, and 3 Hispanic men, were found to carry the AR R726L allele. Therefore, the prevalence of this allele is significantly less than that observed among Finnish men with prostate cancer (Fisher's exact test, P = 0.002). CONCLUSIONS: The AR R726L allele does not account for a significant proportion of early-onset and/or familial prostate cancer in the United States.     

Screening for prostate cancer--how to manage in 2006?

National Societies usually recommend screening for Prostate Cancer (PC) with Serum Prostate Specific Antigen (PSA) and digital rectal examination annually beginning at age 50. In high risk population including men with a family history of PC or African population screening should start at age of 45 years. PSA has been widely used to detect PC despite the fact that PSA is not specific for PC. Over the years serum PSA level of greater than 4.0 ng/ml was considered the treshold to perform prostate biopsy, searching for PC. In 2005 the Prostate Cancer Prevention Trial (PCPT) demonstrated that the cut-off of 4.0 ng/ml for PSA is not anymore adapted due to the fact that this survey found in 15% of men with PSA < or = 4.0 ng/ml a prostate cancer on sextant biopsies. Today the value of PSA and the cut-off for Prostate biopsy is questionned suggesting that PSA level higher than 2.6 ng/ml must be the case to propose Prostate Biopsy. Catalona confirms that approximately 25% to 30% of men with PSA 2.6 to 4.0 ng/ml have prostate cancer. Schr?der and Gosselaar assert that screening for PC at low PSA levels (< 4.0 ng/ml) risks to detect clinically insignificant cancers which are no threat to man. So far in the year 2006 screening for PC demonstrates accumulating evidences of efficacy but persistent uncertainty. The major question for an urologist at work when facing a young men searching early diagnosis of PC is: at which level of PSA do we have to perform rectal biopsy?     

General features and strategy in the diagnosis of prostatic carcinoma

Prostate cancer (PCa) is the most commonly diagnosed cancer in men as well as the second leading cause of cancer death. Age, family history and race are proved risk factors for developing a PCa. Prostate specific antigen (PSA) in combination with the digital rectal examination (DRE) has proven to be an essential element in early prostate cancer detection. Enthusiasm for using transrectal ultrasound (TRUS) alone to identify early prostate cancer has not been demonstrated with longer follow-up. The major role of TRUS today is to ensure accurate wide-area sampling of prostate tissue in men with PCa suspicion. This is best accomplished by targeted biopsy of TRUS-suspicious lesions and systematic biopsy of areas without hypoechoic lesions. Urologists recommend digital rectal examination and a PSA blood test annually starting at age 50.