DIGITAL RECTAL EXAMINATION, SERUM PROSTATE-SPECIFIC ANTIGEN, AND PROSTATIC ULTRASOUND - HOW EFFECTIVE IS THIS DIAGNOSTIC TRIAD

Ninety-nine of 105 consecutive men who underwent transrectal prostatic ultrasound (TRUS) at Highland Park Hospital had the results correlate d with digital rectal examination (DRE), serum prostate specific antig en (PSA), and biopsy results. Ninety-six cases had evaluable ultrasoun d studies. Thirty-two of the 99 who underwent biopsy had primary carci noma of the prostate. Prostate volume, predicted PSA, a ratio of obser ved/predicted PSA, and Gleason score were examined. There was no corre lation between age and prostate volume, volume and the presence of car cinoma, or PSA and Gleason score. Thirty-one point six percent of the abnormal DREs, 36.6% of the abnormal TRUSs, and 40.6% of the elevated PSAs occurred in men with prostatic carcinoma (PCa). If PSA was normal (less than or equal to 4.0 ng/ml) and either DRE or TRUS was abnormal , then the risk of carcinoma was 2.9%. If PSA was elevated, regardless of the other two tests, the risk of finding PCa was at least 38%. If all three tests were abnormal, the risk of carcinoma was 38% in our se ries and 68% in a meta-analysis. Many men with PSA values between 4 an d 10 ng/ml have benign biopsies. However, close future follow-up with consideration of repeat biopsy should be strongly considered. (C) 1994 Wiley-Liss, Inc.