Prostate cancer: comparison of digital rectal examination and transrectal ultrasound for screening.

A prostate cancer screening study of 315 asymptomatic men comparing digital rectal examination and transrectal ultrasound identified 23 cancers, for a detection rate of 7.3%. Of the cancers 17 (5.4%) were diagnosed by digital rectal examination. Contrary to the experience of others, this was a higher rate than achieved by transrectal ultrasound (14 cases or 4.4%). Systematic multiple needle biopsies of both lobes with ultrasound guidance were routinely performed. As a result of this technique 7 of 23 cancers (30%) were fortuitously diagnosed. In addition, only unilateral disease was suspected in 4 of 7 patients with bilateral disease on biopsy. Digital rectal examination and transrectal ultrasound identified the same number of patients with small (less than 1.5 cm.) cancers, contrary to other reports that found transrectal ultrasound to be superior. Digital rectal examination is considered an effective screening examination, equivalent to transrectal ultrasound and preferable because of lower cost. An algorithm for screening is outlined with digital rectal examination and prostate specific antigen determinations.

Prostate cancer: correlation of digital rectal examination, transrectal ultrasound and prostate specific antigen levels with tumor volumes in radical prostatectomy specimens.

Volume and distribution of prostatic carcinoma were measured in 30 radical prostatectomy specimens. Obtaining these data was facilitated by the use of whole tissue mounts. Similar measurements were obtained from preoperative transrectal ultrasound studies. With this information the ability of digital rectal examination and transrectal ultrasound to predict tumor burden was analyzed. It was concluded that both of these examinations are poor predictors of tumor volume, distribution and pathological stage. Preoperative prostate specific antigen levels were correlated with the pathological data. It appeared that prostate specific antigen levels of greater than 10 presage [corrected] tumor volumes of greater than 3 cc, and that levels of more than 50 are suggestive of stages C and D disease.

Fate of the kidney after antireflux surgery.

Representative case reports of children subjected to ureteroplasty in the management of reflux have been presented. Five- to 12-year follow-up studies were analyzed with reference to renal growth and pyelonephritic changes; the effect of the degree of preoperative reflux was recorded. The following conclusions appear warranted: 1. Severity of reflux is a major factor determining renal status; the more marked the reflux, the greater the frequency and extent of CPN. 2. Kidneys which appear normal initially usually remain so;however, CPN may develop, sometimes to a severe degree (Fig. 9). 3. The growth potential of pyelonephritic kidneys is quite variable and not readily predictable (Fig. 9). 4. Prolonged exposure to reflux appears to be an unfavourable situation possibly accelerating renal deterioration.