Prostate-specific antigen coordinated with digital rectal examination and transrectal ultrasonography in the detection of prostate cancer

Abstract

In a patient population, coordinated use of digital rectal examination and prostate-specific antigen can alert the physician as to the possible existence of prostate cancer. If both are used as first-line studies, abnormality of either can then direct the need for further study by transrectal ultrasonography and, in selected instances, prostatic biopsy. Such sequential use of these tests in a programmed manner results in an increased level of cancer detection as compared with use of the digital rectal examination alone.

Does Prostate-Specific Antigen Density Alter Decision Making on Biopsy?

“…Overall, however, BPH and prostatitis appeared to be responsible for PSA elevations in half of the men, and in numerous other series elevated PSA levels were demon strated to be present in 21-47% of patients with BPH [1,9,12], From these studies it was concluded that isolated PSA determinations have insufficient specificity for detection of pCa [1,9], Especially 'gray-zone' PSA values can there fore initiate a sequence of investigations only to confirm benign prostatic conditions. After Stamey et al [5] reported that pCa elevates the serum PSA level 10 times more than BPH, the concept of PSAD was developed [6,7], Several studies recommended PSAD determination in patients with benign DRE and 'gray-zone' PSA levels and histologi cal evaluation for PSAD values of 0.15 or more [7,19], In this study including 144 patients with benign DRE and PSA>4.0 ng/ml significant stratification in mean and median PSAD for patients with positive and negative his- Table 4. Factors influencing serum PSA measurements tological outcome was found.…”

“…Although PSA has a definite value as a marker in moni toring established pCa [4,9], its role in screening is still controversial [10,11], In several studies PSA values have been shown to correlate directly with the clinical and pathological stage of pCa [12][13][14] and 28.5-37% of pa tients with serum PSA levels >4.0 ng/ml might have non palpable pCa [15][16][17]. In all patients with PSA > 10.0 ng/ ml the likelihood of pCa is estimated to be about 67-83% and histological sampling is implicitly advised regardless of normal DRE and/or TRUS [18,19]. In patients with PSA < 4.0 ng/ml pCa might be detected by DRE in 17.8-28.8% [20].…”

Comparison between Digital Rectal Examination, Prostate-Specific Antigen and Transrectal Ultrasound in Symptomatic Patients

“…In fact, as pointed out by Cooner [ 17], we must take care to understand the difference between screening and cancer detection in patients who are under the care of a physician. While the efficacy of the screening test is yet to be determined, the detection of cancer among patients in whom the physician is assessing clinical information, physical examination, serum markers, and TRUS is quite another matter.…”

Prostate Cancer Imaging

“…23 In their reanalysis of data presented by Lee and colleagues, they demonstrate that the positive predictive value of DRE alone (62%) was not enhanced by the addition of ultrasound. In an update of his large ongoing screening study, Cooner 24 has restated the matter from a different perspective. Among his patients with normal DRE and PSA, 40.8 sonograms and 8.5 biopsies would be required to detect a single prostate cancer.…”