Prostate-specific antigen, digital rectal examination, and transrectal ultrasonography: their roles in diagnosing early prostate cancer.

In this article, we review the current status of early detection of prostate cancer. From existing data in the medical and urologic literature, we developed an algorithm that uses the three current methods of detection: digital rectal examination (DRE), determination of the prostate-specific antigen (PSA) value, and transrectal ultrasonography (TRUS). Prostatic malignant disease is an increasing medical problem in the United States. The potential for cure is optimized by early detection and treatment of organ-confined disease. Mass screening for prostate cancer in asymptomatic men cannot be advocated until a decrease in the mortality rate is established by randomized, controlled studies; however, these data will be unavailable for at least 15 years. In the meantime, clinicians must prudently use DRE, PSA, and TRUS for early detection. Current data indicate that the PSA level is as effective as or more effective than DRE for the detection of prostate cancer. These two methods do not always detect the same malignant tumor; therefore, the combined use of DRE and PSA testing provides a more complete evaluation of the prostate gland for malignant involvement. TRUS is more costly and does not add appreciable detectability when results of both the DRE and the PSA determination are normal. Thus, TRUS is best reserved for patients who have abnormal results of DRE or increased PSA values.