Relative contribution of digital rectal examination and transrectal ultrasonography in interpreting serum prostate-specific antigen values for screening prostate cancer in Arab men

• Published in: Annals of Saudi medicine 2007-03, Vol.27 (2), p.73-78
• Main Authors: Sheikh, Mehraj, Sinan, Tariq, Kehinde, Elijah O, Hussein, Ali Yt, Anim, Jehoram T, Al-Hunayan, Adel A
• Format: Article
• Language: English
• Subjects: Aged; Arabs; Digital Rectal Examination; Humans; Male; Mass Screening; Predictive Value of Tests; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - epidemiology; Ultrasonography
• ISSN: 0256-4947; 0975-4466
• DOI: 10.4103/0256-4947.51521

This study was conducted to determine the utility of digital rectal examination (DRE), transrectal ultrasonography (TRUS) and serum prostate-specific antigen (PSA) in the diagnosis of prostate cancer in men in Arabia, an are of the world with a relatively low incidence of this disease. 329 patients suspected of having prostate cancer on account of raised serum PSA level (>4 ng/ml), DRE or TRUS findings, underwent TRUS-guided prostate biopsy. Raised PSA individually as well as combined, or a lesion suspicious of carcinoma on DRE or TRUS was recorded as PSA(+), DRE(+) or TRUS(+), respectively. The contribution of DRE, TRUS and serum PSA to the diagnosis of prostate cancer was analysed. Of the 329 patients who had prostate biopsies 109 cases (33.1%) had PCa. Of these 109 patients 56 (51%) had DRE(+), 77 (42%) had TRUS(+) and 49 (66%) had both DRE(+) and TRUS(+). Statistical analysis revealed that DRE(+) tripled the probability for cancer. PSA over a range of 10-50 ng/mL demonstrated an increasing cancer probability ranging from 2 to 3 fold. TRUS(+) was only significantly associated with cancer risk if PSA was elevated. The presence of all three factors increased the cancer probability by 6 to 7 fold. TRUS findings are dependent on PSA for interpretation while DRE(+) with elevated PSA makes PCa more likely.