BIOPSY-PROVED PROSTATE-CANCER IN 100 CONSECUTIVE MEN WITH BENIGN DIGITAL RECTAL EXAMINATION AND ELEVATED SERUM PROSTATE-SPECIFIC ANTIGEN LEVEL

To determine whether a significant percentage of patients with a benig n digital rectal examination (DRE) and an elevated serum prostate-spec ific antigen (PSA) level harbor a prostatic malignancy, 1 00 consecuti ve patients underwent transrectal ultrasound (TRUS)-guided biopsy of t he prostate. The biopsy results were correlated with the pre-biopsy se rum PSA level and ultrasound findings. Overall, the cancer detection r ate was 35 percent (S.E. 4.8%). When the biopsy results were analyzed according to the PSA level, the rate of cancer detection increased wit h advancing PSA levels, irrespective of ultrasound findings. In the 60 patients with ultrasound abnormalities, the cancer detection rate was 47 percent compared with 18 percent for those without ultrasound abno rmalities. Comparison of TRUS-negative and TRUS-positive biopsy result s revealed a more than two-fold increase in cancer detection for the T RUS-positive group in each PSA range. Cancer detection in the TRUS-pos itive, PSA 4.1-10, 10.1-20.0, and > 20 ng/mL groups was 40 percent, 56 percent, and 67 percent, respectively; in the TRUS-negative group, ca ncer detection was 12 percent, 27 percent, and 33 percent, respectivel y. Twenty (57%) of the patients with prostate cancer underwent radical retropubic prostatectomy. The mean tumor volume was 4.7 cc. Seventy p ercent had organ-confined disease, 30 percent demonstrated capsular pe netration only, and no patients had seminal vesicle or pelvic lymph no de invasion. These data indicate that a significant percentage of pati ents with a benign DRE and an elevated serum PSA value harbor a clinic ally significant, but potentially curable prostatic malignancy.