In 3 years of mass screening for early diagnosis of prostatic cancer, 57 tumors were found (57/5000, for a detection rate of 1.2%). Patients first underwent digital rectal examination (DRE): at present the least expensive, least invasive and most effective way to diagnose prostatic cancer. 420 men underwent transrectal ultrasonography (TRUS) with a 5 MHz transverse and longitudinal transducer for pathological digital rectal findings, obstructive symptoms and other reasons. Prostatic biopsy was performed in 190 patients with DRE findings and/or hypoechoic zones of the prostatic gland (transrectal digitally directed or ultrasonically perineal guided biopsies). The specificity, sensitivity and prediction capacity of DRE and TRUS in this group of patients was evaluated. Sensitivity of DRE was 92%, specificity 42% (usual finding for mass screening); predictive positive value was 41 %, negative 93%. Sensitivity of TRUS was 77%, specificity 57%, predictive positive value was 44%, negative 86%. Data seem to confirm the ability of TRUS to reduce the number of “false positives” after DRE (and consequently the number of biopsies). However, contraindications for use in mass screenings are: sensitivity lower than with DRE, high false positive rate and prohibitive cost for systematic use. Validity of TRUS is confirmed in clinical staging for the selection of patients undergoing radical retropubic prostatectomy, by comparison with local pathological staging.

Cellular proliferation in the prostatic ducts and acini presents a morphological continuum from benign proliferation without cytological atypia (hyperplasia) to proliferations with different degrees of dysplasia. The term prostatic intraepithelial neoplasm (P.I.N.) indicates the theoretical morphological extremity of that continuum. The criteria for differentiating P.I.N. into three grades are to be found in the cytological and architectural aspect as well as the integrity of the basal cell layer and the basal membrane. Clinically P.I.N. is strongly associated with prostatic carcinoma and diagnosis should be followed by further investigations for a co-existing carcinoma. All the elements (age, severity of P.I.N., P.S.A., D.R.E. and T.R.U.S. characteristics) which may be used for correct follow-up are discussed, as well as possible therapeutic options.

After having summarised the indications, the authors describe the various incontinent external urinary diversions (ileal, colie and ileo-cecal duct), the most common surgical solutions. The most salient features from a technical point of view and possible immediate and late complications are analysed.

From September 1992 to February 1994, 1441 men aged between 50 and 70 years underwent screening with PSA and ER measurement for early diagnosis of prostatic carcinoma. A neoplasm was diagnosed in 1.73% (25/1441) of cases, which being found at an early stage, made it possible to perform prostatectomy and radical radiotherapy on 37.5% and 16.6% of patients respectively. The incidence of the disease was higher than in a previous screening with just ER dosage (1.73% vs 1.1%). Combined PSA and ER also gave higher sensitivity, specificity, overall accuracy and predictiveness compared to the methods taken individually. This combination seems preferable, in view of the greater efficacy and “practicability” compared to protocols which involve the use of USTR, which is less practicable on a large scale due to the length of time required and high costs. The utility of periodic determination of PSA levels in those over fifty years old is emphasised, both for oncological screening controls and to increase the diagnostic accuracy of other clinical tests.

Early-stage prostate cancer is usually asymptomatic and therefore, in the past, has often gone undetected, unless diagnosed by a digital rectal examination. Recently, in order to improve the detection of early stage disease, new tests have been introduced, namely prostate specific antigen and transrectal ultrasound. Considerable debate exists not only about the usefulness of the screening but also about the routine use of these tests. In this article the features of these tests, single or in combination are discussed, and how to perform follow-up of the patient already submitted to screening for prostatic carcinoma.