Rectal examination and ultrasonography in the diagnosis of prostate cancer

Most patients with prostate cancer have disease that has extended beyond the confines of the gland at the time of diagnosis. The effect of earlier detection on morbidity and death requires further study, as does assessment of prognostic factors and optimal therapy for individual patients. Recent reports indicate the utility of using prostate specific antigen and digital rectal examination as preliminary tests to identify patients in whom further study by prostate ultrasonography will improve detection rates. The algorithm presented may be a useful guide in sequencing detection approaches. The value of mass screening for prostate cancer by any existing means remains unproven.