The purpose of this study was to evaluate the efficacy of various diagnostic tests including transrectal ultrasound (TRUS), TRUS guided biopsy, digital rectal examination (DRE),
prostate specific antigen (PSA), and
prostate specific antigen density (PSAD) in detecting prostatic
carcinomas. One hundred and thirty-four men underwent TRUS guided random, or directed and random sonographic biopsies of the prostate. The mean age was 64.67 (range, 31- 88) years. Indications for biopsy were abnormal findings suggesting prostatic
carcinoma on DRE or increased levels of PSA, defined as 4.0 ng/ml or greater in a
monoclonal antibody assay. PSAD was calculated by dividing the serum PSA in ng/ml to the volume of the entire prostate in cm3. The biopsy results were grouped as benign, malign and,
prostatitis. The patients were also divided into three groups according to their PSA values. Of the 134 patients evaluated, 31 (23.1%) had prostate
adenocarcinoma, 89 (66.4%) had benign prostatic tissue,
hyperplasia or
prostatic intraepithelial neoplasia, and 14 (10.4%) had
prostatitis. The mean PSA and PSAD of the
carcinoma group were significantly higher than those of the noncancer group. In the group of patients with PSA levels between 4 and 10 ng/ml, abnormal TRUS or DRE increased
cancer detection rate, where neither PSA nor PSAD was capable of discriminating the patients with and without
cancer. PSAD did not prove to be superior to the other diagnostic tests in this study. We recommend biopsy when either TRUS or DRE is abnormal in patients with PSA levels between 4 and 10 ng/ml. In the patients with PSA levels greater than 10 ng/ml, biopsy is indicated whatever the findings on TRUS or DRE are, since
cancer detection rate is high.