OBJECTIVE: To detect curable prostate cancer in a male Spanish population. The results of screening 2,576 men are reported. PATIENTS AND METHODS: Patients underwent digital rectal examination (DRE) and serum prostate-specific antigen (PSA) determination. Any patient with suspicious DRE or PSA > 4 ng/ml was further evaluated with transrectal ultrasonography (TRUS) and biopsy. The sensitivity, specificity and predictive value of the tests or combinations of tests were determined. RESULTS: Mean age was 59.9 years (median 58 years). Ninety-four patients (3.6%) had abnormal DRE while PSA was > 4 ng/ml in 169 patients (6.5% of the total). We needed 6.8 biopsies to prove one cancer. PSA had the highest sensitivity (93%), whereas DRE had the highest specificity (97%). The positive predictive value rose to 78.9% when both DRE and PSA were abnormal. Clinically advanced tumor stages (> or = T3) were commoner (39.4%) than in similar series. CONCLUSIONS: PSA should be the first diagnostic test in a screening program for prostate cancer. Neither DRE nor TRUS are necessary in patients with PSA < 4 ng/ml. In the light of our findings, we cannot encourage screening programs for prostate cancer for the time being.
OBJECTIVE: To detect curable prostate cancer in a male Spanish population. The results of screening 2,576 men are reported. PATIENTS AND METHODS: Patients underwent digital rectal examination (DRE) and serum prostate-specific antigen (PSA) determination. Any patient with suspicious DRE or PSA > 4 ng/ml was further evaluated with transrectal ultrasonography (TRUS) and biopsy. The sensitivity, specificity and predictive value of the tests or combinations of tests were determined. RESULTS: Mean age was 59.9 years (median 58 years). Ninety-four patients (3.6%) had abnormal DRE while PSA was > 4 ng/ml in 169 patients (6.5% of the total). We needed 6.8 biopsies to prove one cancer. PSA had the highest sensitivity (93%), whereas DRE had the highest specificity (97%). The positive predictive value rose to 78.9% when both DRE and PSA were abnormal. Clinically advanced tumor stages (> or = T3) were commoner (39.4%) than in similar series. CONCLUSIONS:PSA should be the first diagnostic test in a screening program for prostate cancer. Neither DRE nor TRUS are necessary in patients with PSA < 4 ng/ml. In the light of our findings, we cannot encourage screening programs for prostate cancer for the time being.