Summary
In a prospective study the statistical characteristics of digital rectal examination (DRE), transrectal ultrasound (TRUS), and serologic determination of prostate-specific antigen (PSA) were assessed in 1230 patients aged over 40 years. The sensitivity, specificity, and positive and negative predictive values were determined to be 80.3%, 69.7%, 58.9%, and 86.7%, respectively, for DRE; 76.5%, 62.3%, 52.3%, and 83.1%, respectively, for TRUS; and 87.9%, 49.6%, 48.5%, and 88.3%, respectively, for PSA (normal level, 4 ng/ml). The data clearly demonstrate the nonsuitability of each single measure for reliable early detection of prostatic carcinoma. Connection of the parameters in all possible combinations under various conditions demonstrated the superiority of the test “DRE and PSA >4 ng/ml” over DRE as the “gold standard” and all other options. The use of this approach as the first-line raster of an algorithm (outlined herein) would allow the detection of prostatic malignancy with a specificity of 86.5% and a positive predictive value of 74.0%. Supplementing this screen with short-term controls in cases in which only one parameter is positive (“DRE or PSA >4 ng/ml”) might enable the detection of almost all patients with prostate cancer. TRUS did not provide any additional information.
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References
Allhoff E, Bading R, Hoene E, Jonas U (1988) The bifocal multiplane transrectal transducer: a valuable adjunct to physical and immunochemical findings for early detection of prostate cancer. World J Urol 6:27–30
Carter HB, Andres R, Metter JE, Fozard JL, Chan DW, Walsh PC (1991) Early detection of prostate cancer using serial PSA measurements. J Urol 145 [Suppl 4]:382A
Catalona WJ (1984) Natural history. In: Catalona WJ (ed) Prostate cancer. Grune & Stratton, Orlando, pp 40–47
Catalona WJ, Smith DS, Ratliff TL, Dodds KM, Coplen DE, Yuan JJJ, Petros JA, Andriole GL (1991) Measurement of prostate specific antigen in serum as a screening test for prostate cancer. N Engl J Med 324:1156–1161
Chodak GW, Wald V, Parmer E, Watanabe H, Ohe H, Saitoh M (1986) Comparison of digital examination and transrectal ultrasonography for the diagnosis of prostatic cancer. J Urol 135:951–953
Daehnert WF, Hamper UM, Eggleston JC, Walsh PC, Sanders RC (1986) Prostatic evaluation by transrectal sonography with histopathologic correlation: the echopenic appearance of early carcinoma. Radiology 158:97–102
Guinan P, Rubenstein M (1987) Methods of early diagnosis in genitourinary cancer. Cancer 60:668–676
Hermanek P, Sobin LH (eds) (1987) TNM classification of malignant tumours. Springer, Berlin Heidelberg New York
Krauss DJ, Lilien OM (1975) The benign killer: carcinoma of the prostate. J Urol 113:820–823
Palken M, Cobb OE, Simons CE, Warren BH, Aldape HC (1991) Prostate cancer: comparison of digital rectal examination and transrectal ultrasound for screening. J Urol 145:86–90 (discussion, 90–92)
Paulson DF, Lin GH, Hinshaw W, Stephani S, the Uro-Oncology Research Group (1982) Radical surgery versus radiotherapy for adenocarcinoma of the prostate. J Urol 128:502–504
Prorok PC, Connor RJ, Baker SG (1990) Statistical considerations in cancer screening programs. Urol Clin North Am 17:699–708
Rifkin MD, Friedland GW, Shortliffe L (1986) Prostatic evaluation by transrectal endosonography: detection of carcinoma. Radiology 158:85–90
Schmidt JD, Mettlin CJ, Natarajan N, Peace BB, Beart RW Jr, Winchester DP, Murphy GP (1986) Trends in the patterns of care for prostatic cancer, 1974–1983: results of surveys by the American College of Surgeons. J Urol 136:416–421
Thompson IM, Ernst JJ, Gangai MP, Spence CR (1984) Adenocarcinoma of the prostate: results of routine urological screening. J Urol 132:690–692
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Acknowledged with the Cancer Award of the State of Lower Saxony, Germany, 1992.
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Allhoff, E.P., Liedke, S.G., Gonnermann, O. et al. Efficient pathway for early detection of prostate cancer concluded from a 5-year prospective study. World J Urol 11, 201–205 (1993). https://doi.org/10.1007/BF00185069
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DOI: https://doi.org/10.1007/BF00185069