SENSITIVITY, SPECIFICITY AND POSITIVE PRE DICTIVE VALUE OF PSA, PSA-DENSITY, DIGITAL RECTAL EXAMINATION AND TRANSRECTAL ULTRASONOGRAPHY IN THE EARLY DETECTION OF PROSTATE-CANCER

The results of 255 systematic biopsies of the prostate from 1992 and 1 993 were evaluated retrospectively and compared with the histological specimen. We examined digital rectal examination (DRE), transrectal ul trasound (TRUS) and prostate-specific antigen (PSA). Besides these sin gle parameters and possible combinations we analysed age-specific-PSA- reference values and calculated the PSA-density. The sensitivity for t he single parameters was about 90%; the highest value (94.2%) was obta ined by TRUS with a specificity of 38.1%. Age-specific-PSA-values had a comparable specificity (38.4%), but sensitivity was only 80.8%. The PSA-density (cut-off level 0.15) for patients with PSA-values between 2.0 and 10.0 ng/ml had a sensitivity of just 20%, but specificity was very high (81.8%). The combination of DRE and PSA for screening of PC seems to be the best compromise in terms of good sensitivity, simple a pplication and cost-efficiency. Transrectal ultrasound should be appli ed additionally if PSA or DRE indicates suspicion of carcinoma. The co mbination of DRE, TRUS and PSA above 10 ng/ml has the highest positive predictive value (80.7%).