Hypothetical Place of Transrectal Ultrasound in the Diagnosis of Prostatic Cancer at an Early Stage

In order to clarify the place of transrectal prostatic ultrasound examination (TRPS) in the diagnosis of prostatic cancer at early stage, 666 patients have been screened in 1 year. Of these, 602 had a normal, firm, or hyperplastic but nonnodular prostate (T₀) by digital rectal examination (DRE); 41 had a T₁-T₂ prostate; and 23 had a T₃-T₄ prostate. Among those with T₀ prostates, 162 had a hypoechoic peripheral area, which was biopsied: 11 lesions were infiltrating carcinomas. The ability to detect a T₀ cancer with TRPS alone is assessed at 1.8% (11/602). The positive predictive value of a hypoechoic image of the prostate is assessed at 7% (11/162), which is much lower than the figures reported in the literature. TRPS can be considered an acceptable means of detecting T₀ tumors of the prostate with a yield comparable to that of DRE in the T₁-T₄ tumors. The low performance (1.8%) of TRPS in detecting cancer at early stage rules out massive screening program of the male population over 50 years old. However, 45% of the localized tumors in this series were picked up by TRPS alone.