Screening for Prostatic Cancer with High-Resolution Ultrasound

Between August 1986 and April 1987, 765 consecutive patients were screened for prostate cancer using digital palpation and transrectal ultrasound. Patients were self-referred, having responded to media solicitation for prostate cancer screening. They were 50 years or older and had no symptoms suggesting prostate cancer. A total of 52 biopsy-verified cancers were detected, and seven additional cancers were statistically predicted to occur in the screened group, giving an overall prevalence of prostate cancer in this population of 7.7%. Twenty-nine of the cancers were palpable, whereas 23 were detected only by ultrasound. Ultrasound sensitivity was 85% and digital sensitivity 61%. Prostate specific antigen was measured in 43 of the 52 cancer patients and was found to be within normal limits in 8 (19%). The finding, in the 60-69 age group, of seven ultrasound-positive/digital-negative cancers with Gleason pattern scores of 5 or more is an indication that these nonpalpable malignancies are biologically aggres...