INCIDENTAL CARCINOMA OF THE PROSTATE

Transrectal ultrasonography (TRUS); digital rectal examination (DRE), and quantification of serum prostate-specific antigen (PSA) are accept ed and evaluated methods for detecting prostate cancer. Positive predi ctive values (PPV) of DRE and TRUS are low, and only slightly enhanced when used in combination with PSA. PSA lacks sufficient sensitivity a nd specifity to be used alone as a screening test for prostate cancer. The parameters PSA-density and PSA-velocity make PSA a better tumor m arker, but they are not reliable on an individual basis. Age-specific reference ranges have the potential to make PSA a more sensitive tumor marker for men less than 60 years of age ana a more specific one for men beyond 60 years. With currently available diagnostic methods appro ximately 10% of patients undergoing transurethral or open resection of the prostate for presumed benign prostatic hyperplasia will have carc inoma detected in the histologic material. In 392 patients successivel y treated in our clinic for presumed BPH and thoroughly investigated t o exclude prostatic carcinoma (DPE, TRUS, biopsy when PSA > 4 ng/ml or PSA-D > 0.15), the tumor was found incidentally in 4%. Another findin g in this study was the detection of prostatic carcinoma by random bio psy in patients without a palpable or visible tumor by imaging and wit hout PSA increase (> 4 ng/ml). Biopsies were performed because of a hy poechoic zone in the opposite lobe which turned out to be negative. Su ch tumors cannot be properly classified in the current TNM system. Tre atment options for patients with incidental prostatic carcinoma are ag e- and stage-dependent. Patients less than 60 years old may be treated with a curative approach, irrespective of the T category (T1a or T1b) ; patients with a life expectancy longer than 10 years and a pT1b inci dental carcinoma likewise should be offered a curative therapy. (C) 19 95 Wiley-Liss, Inc.