Screening for Prostatic Cancer with High-Resolution Ultrasound

Abstract

Between August 1986 and April 1987, 765 consecutive patients were screened for prostate cancer using digital palpation and transrectal ultrasound. Patients were self-referred, having responded to media solicitation for prostate cancer screening. They were 50 years or older and had no symptoms suggesting prostate cancer. A total of 52 biopsy-verified cancers were detected, and seven additional cancers were statistically predicted to occur in the screened group, giving an overall prevalence of prostate cancer in this population of 7.7%. Twenty-nine of the cancers were palpable, whereas 23 were detected only by ultrasound. Ultrasound sensitivity was 85% and digital sensitivity 61%. Prostate specific antigen was measured in 43 of the 52 cancer patients and was found to be within normal limits in 8 (19%). The finding, in the 60-69 age group, of seven ultrasound-positive/digital-negative cancers with Gleason pattern scores of 5 or more is an indication that these nonpalpable malignancies are biologically aggressive. A full 40% of the smaller cancers (ultrasound diameter of 1.5 cm or less) in this series were missed by the digital examination. We conclude that transrectal ultrasound screening improves the chances of early detection for prostate cancer and will likely improve survival.