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[Clinical utility of available diagnostic tests in prostatic carcinoma. Results of 500 biopsies. II. Rectal palpation, PSA, and transrectal echography].

OBJECTIVE
To analyze and compare the diagnostic yield of transrectal ultrasound versus digital rectal examination (DRE) and PSA.


METHODS
500 patients with a suspicion of carcinoma of the prostate were evaluated by US-guided transrectal biopsy, PSA determination and DRE. The sensitivity, specificity and predictive values of these diagnostic methods, utilized alone or in combination, were analyzed.


RESULTS
44.8% of the patients had evidence of cancer in the biopsy specimen. DRE disclosed an indurated prostate in 32% and 45% of the ultrasound scans were suspicious of malignancy (74.2% of those in whom a tumor was demonstrated and 20.4% of those with no tumor, p < 0.001). DRE, PSA > 4 ng/ml and transrectal ultrasound had a sensitivity rate of 52%, 93% and 74%, and a specificity of 85%, 10% and 79%, respectively. The highest sensitivity rate was obtained when biopsy was indicated by an indurated prostate on DRE or PSA > 4 ng/ml or a suspicious transrectal ultrasound scan (96%). The highest diagnostic accuracy, with a specificity of 96%, was obtained in patients with PSA > 10 ng/ml and positive DRE and transrectal ultrasound.


CONCLUSION
The combined use of the different tests is fundamental to early diagnosis of prostatic cancer. In our experience, transrectal ultrasound was the method which independently obtained the best predictive values, offering a high sensitivity and specificity.