Prostate cancer detection with digital rectal examination, prostate-specific antigen, transrectal ultrasonography and biopsy in clinical urological practice

OBJECTIVE To evaluate the utility of digital rectal examination (DRE), prostate specific antigen (PSA) and transrectal ultrasonography and biopsy (TRUSB) in detecting prostate cancer in one teaching-hospital urological practice. PATIENTS AND METHODS In all, 2800 consecutive patients had TRUSB as outpatients by one urologist, the indications for which were a raised or rising PSA level or an abnormal DRE. In addition, the indications for repeat TRUSB included previous abnormal histology, e.g. suspicious areas or atypia or high-grade prostatic intraepithelial neoplasia. All data were collected prospectively. RESULTS Of 2800 TRUSB, 223 were known cases of prostate cancer (previously diagnosed from transurethral prostatectomy chips or after radical prostatectomy) and were excluded from the analysis. There were 2194 initial and 383 repeat TRUSB; of the former patients, 1129 were found to have prostate cancer, giving a cancer-detection rate of 52%. The positive predictive values (PPVs) for patients with a normal DRE and PSA of <4, 4-10 and >10 ng/mL were 9%, 31% and 48%, respectively; the corresponding PPVs for patients with an abnormal DIRE and the same PSA levels were 27%, 67% and 85%, respectively. Of the 383 repeat TRUSB, the cancer-detection rate was 31% for the first repeat and 28% for the second. CONCLUSIONS The present values are higher than those reported previously, because these patients were within a clinical urological practice, and the indications for and methods of TRUSB have changed in recent years, such that more lateral areas were biopsied. These values are useful in helping clinicians to counsel patients about the probability of detecting cancer.