Prostate cancer screening using fine-needle aspiration cytology prior to open prostatectomy

We performed a prospective study to evaluate fine-needle aspiration (FNA) cytology as a screening tool of carcinoma of the prostate in 159 men with normal digital rectal examinations and acid phosphatase prior to open prostatectomy for voiding symptoms. The incidence of carcinoma of the prostate was 5.6%. 4 patients had A1 lesions and 5 had A2 lesions. Only one A2 lesion was malignant cytologically. The sensitivity was 56%, specificity 69%, positive predictive value 24% and negative predictive value 90%. Sufficient cytologic specimens were provided in 66% of cases. While FNA is at least equal to core biopsy as a diagnostic modality of palpable prostatic abnormalities, it does not prove to be an adequate screening modality for occult carcinoma of the prostate in the prostatectomy candidate.