Prostate cancer screening: Role of digital rectal examination and prostate-specific antigen |
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Authors: | Dr Jerome P Richie MD Louis R Kavoussi MD George T Ho MD Martyn A Vickers MD Michael A O'Donnell MD Donna St Laurent BS Antony Chen MD David S Goldstein MD Kevin R Loughlin MD |
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Institution: | (1) From the Division of Urologic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA |
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Abstract: | Background: This study was designed to determine the efficacy of digital rectal examination (DRE) and serum prostate-specific antigen
(PSA) for early detection of prostate cancer in men ≥50 years of age.
Methods: A prospective single-center clinical trial was conducted to screen 644 asymptomatic men, who were elicited by newspaper and
radio advertisements, with DRE and PSA. Quadrant biopsy examinations of the prostate were performed if PSA >4 ng/ml or if
DRE was suspicious.
Results: Thirty-seven percent of the men (n=241) had an abnormality of DRE or elevated PSA. Of the 163 patients who underwent transrectal
ultrasound and quadrant biopsies of the prostate, 77% had normal biopsies, 14 (8%) had prostatic intraepithelial neoplasia,
and 24 (15%) had carcinoma of the prostate. PSAs ranged from 0.3 to 65.5 ng/ml, with a mean of 2.35 and a median of 1.6. Ninety-five
patients had a PSA >4 ng/ml, of whom 17 had a PSA >10 ng/ml. Sensitivity of PSA was 75% and specificity 87%; for DRE the sensitivity
was 75% and the specificity 69%. Clinical stage of patients who underwent radical prostatectomy was B1 in 15 and B2 in five.
Fifteen of 20 patients (75%) had organ-confined disease; the other five had specimen-confined disease. No patient was found
to have nodal involvement.
Conclusion: The combination of PSA and DRE seems to improve the stage of diagnosis of patients with prostate cancer. Larger, randomized
studies will be necessary to evaluate the effect of screening on overall survival.
The results of this study were presented at the 46th annual cancer symposium of the Society of Surgical Oncology, Los Angeles,
California, March 18–20, 1993. |
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Keywords: | Screening Prostate neoplasms Prostate-specific antigen |
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