The status of prostate cancer early detection.

Prostate cancer represents an increasing public health burden that may be controlled by early detection interventions. Several studies using transrectal ultrasound (TRUS), prostate-specific antigen (PSA), and digital rectal examination (DRE) in men without known prostate disease have been reported. Recent studies are reviewed, and recent preliminary results of the American Cancer Society-National Prostate Cancer Detection Project (ACS-NPCDP) are presented. Results show that the rate of early prostate cancer detection can be increased by coordinated use of TRUS, PSA, and DRE. The ACS-NPCDP data indicate that the positive predictive value of recommendations to biopsy is improved when based on a combination of studies. Examination by TRUS alone is least specific and least cost-effective, whereas the combination of PSA and DRE is less costly and more specific with equal sensitivity to cancer. Additional data are needed to determine if prostate cancer death rates will be altered by early detection interventions. Physicians and patients need to be informed of the possible risks and benefits of early detection interventions.