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Related Experiment Videos

Diagnostic testing for prostate cancer detection: less is best

R J Babaian1, C P Dinney, E I Ramirez

  • 1Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston.

Urology
|May 1, 1993
PubMed
Summary

Digital rectal examination (DRE) and prostate-specific antigen (PSA) screening effectively detects prostate cancer. Combining DRE and PSA is a cost-effective primary strategy, with transrectal ultrasonography (TRUS) reserved for abnormal initial results.

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Area of Science:

  • Urology
  • Oncology
  • Diagnostic Imaging

Background:

  • Early detection of prostate cancer has improved using digital rectal examination (DRE), transrectal ultrasonography (TRUS), and prostate-specific antigen (PSA) tests.
  • Prostate cancer diagnosis relies on a combination of these screening modalities.

Purpose of the Study:

  • To evaluate the diagnostic efficacy and cost-effectiveness of different combinations of DRE, TRUS, and PSA for early prostate cancer detection.
  • To determine the optimal strategy for primary screening of prostate cancer.

Main Methods:

  • Biopsies were conducted on 436 men with abnormal findings from DRE, TRUS, or PSA.
  • The diagnostic yield and positive predictive value (PPV) of individual tests and their combinations were analyzed.
  • Cost comparison between screening strategies was performed.

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Main Results:

  • Histologic confirmation of prostate cancer was found in 39% of men biopsied.
  • Transrectal ultrasonography (TRUS) showed the highest individual cancer detection rate (94%).
  • The combination of digital rectal examination (DRE) and prostate-specific antigen (PSA) demonstrated a significantly higher positive predictive value (PPV) than TRUS and PSA (p = 0.01) and was cost-effective, missing only 4 cancers.

Conclusions:

  • The combination of digital rectal examination (DRE) and prostate-specific antigen (PSA) is recommended as the primary screening strategy for early prostate cancer detection.
  • Transrectal ultrasonography (TRUS) should be reserved for cases where DRE or PSA results are abnormal to optimize resource allocation and cost-effectiveness.