The diagnosis of prostatic carcinoma.

The increased incidence of prostatic carcinoma is the result of several factors including increased awareness among clinicians and the public of the significance of carcinoma of the prostate, the aging of the American population, and improvements in diagnostic methods. Most patients in whom prostatic cancer currently is diagnosed are evaluated because of symptoms of bladder outlet obstruction or abnormalities found by digital rectal examination (DRE). Incidentally detected carcinoma of the prostate on simple prostatectomy specimens (transurethral resection or open) occurs in 10-20% of patients. DRE abnormalities, leading to prostatic needle biopsy, explain most of the remaining diagnoses. Rarely, patients have other signs and symptoms, such as azotemia, weakness, anemia, and bone pain. Needle biopsy of the prostate is performed, generally, in the United States; however, aspiration cytologic examination is used widely in Europe. Ultrasound-guided needle biopsy is gaining increasing utility in many centers, all but replacing digitally guided prostate biopsies. The role of transrectal ultrasonography for diagnosis recently has fallen into some disfavor. Prostate-specific antigen assays represent a potentially important diagnostic test for prostatic cancer; however, its utility in this regard continues to be investigated.