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Digital rectal examination, serum prostate specific antigen, and prostatic ultrasound: How effective is this diagnostic triad?
Author(s) -
Haid Max,
Rabin David,
King Karen M.,
Feinstein Charles M.,
Janson Kenneth L.,
Levine Stanley R.,
Mutchnik David L.,
Lambiase Elyse A.,
Bradley Richard
Publication year - 1994
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.2930560108
Subject(s) - medicine , rectal examination , triad (sociology) , prostate specific antigen , prostate , urology , prostatic diseases , ultrasound , antigen , radiology , immunology , cancer , psychology , psychoanalysis
Ninety‐nine of 105 consecutive men who underwent transrectal prostatic ultrasound (TRUS) at Highland Park Hospital had the results correlated with digital rectal examination (DRE), serum prostate specific antigen (PSA), and biopsy results. Ninety‐six cases had evaluable ultrasound studies. Thirty‐two of the 99 who underwent biopsy had primary carcinoma of the prostate. Prostate volume, predicted PSA, a ratio of observed/predicted PSA, and Gleason score were examined. There was no correlation between age and prostate volume, volume and the presence of carcinoma, 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 series and 68% in a meta‐analysis. Many men with PSA values between 4 and 10 ng/ml have benign biopsies. However, close future follow‐up with consideration of repeat biopsy should be strongly considered. © 1994 Wiley‐Liss, Inc.