Attitudes of European urologists to early prostatic carcinoma. I. Diagnostic work-up on suspected prostatic cancer cases.

The diagnostic work-ups of 656 European urologists on theoretical cases of suspected early prostatic carcinoma were surveyed. The diagnostic work-ups varied considerably among the urologists. There was strong agreement that digital rectal examination (DRE) and prostate-specific antigen (PSA) should be used routinely in these cases, but there was a lack of agreement concerning the use of transrectal ultrasound examination (TRUS), prostate biopsies and bone scan. However, the use of TRUS, bone scan and biopsies was correlated positively to the PSA level and negatively to age (p < 0.0001), but was not correlated to whether the patient was asymptomatic or suffered from prostatism. Ninety-two percent of the urologists would perform biopsies if a palpable lesion were present. If the PSA was elevated, 22% would use biopsies if it was 7 ng/l, 62% if it was 15 ng/l and 83% if it was 35 ng/l. These results indicate that a majority of European urologists would attempt to diagnose prostatic cancer with biopsies only when results of DRE and PSA predict a high risk that the cancer is no longer organ-confined.