IS TRANSRECTAL ULTRASONOGRAPHY NEEDED TO RULE OUT PROSTATIC-CANCER WITH NORMAL FINDINGS AT DIGITAL RECTAL EXAMINATION AND NORMAL SERUM PROSTATE-SPECIFIC ANTIGEN

In a prospective study, 288 consecutive patients without evidence for prostatic carcinoma at digital rectal examination (DRE) and scheduled for prostatectomy because of benign prostatic hyperplasia (BPH) were e xamined by transrectal ultrasonography (TRUS) and serum prostate-speci fic antigen (PSA) measurement prior to surgery. 46 patients were found to have a carcinoma at histological examination of the surgical speci mens. 14 carcinomas were detected preoperatively by TRUS and biopsy (1 0pT1, 3pT2, 1pT3) of 32 patients with suspicious, i.e., hypoechoic, le sions at TRUS. Among the remaining 256 patients with normal findings a t TRUS, another 32 carcinomas were found at histological examination o f the surgical specimen. Of the 14 carcinomas detected by TRUS, 13 wer e found within a group of 57 patients with PSA levels > 7 ng/ml corres ponding to a cancer detection rate of 22.8% in this group. In 231 pati ents with PSA<7 ng/ml, the use of TRUS was successful in detecting onl y 1 carcinoma (cancer detection rate 0.4%). These results suggest that the use of TRUS is dispensible in 80% of palpably normal patients wit hout affecting the cancer detection rate.