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Two hundred consecutive patients with presumed localized prostate cancer had radical prostatectomy alone (n = 119) or were treated for an average period of 3 months with combination therapy using the antiandrogen flutamide and one luteinizing hormone-releasing hormone (LHRH) agonist (Lupron or Zoladex). The positive margins decreased from 35.3% in the group undergoing prostatectomy alone to 11.5% in the group of men who received combination therapy before radical prostatectomy. In 41 apical tumors, the incidence of positive margins decreased from 50% in the control group to 18.6% in the combination therapy group. In stage C disease, the incidence of positive tumor showed a tendency to decrease with the extended duration of endocrine treatment with a rate of 37.5% after 3 months and 16.7% after 6 months. Whether the decreased incidence of positive surgical margins will all translate into prolonged survival remains to be verified by long-term follow-up of these patients. However, the initial results obtained in the present study are very encouraging.

Three hundred and ninety eight self-referred men with no histories of prostate problems were followed once each year for up to four years to determine the feasibility of early prostate cancer detection by digital rectal examination, transrectal ultrasound, and prostate-specific antigen. Evaluation of prostate-specific antigen was based on a polyclonal level of normal of 2.6 nanograms per milliliter by the Yang assay. Biopsies were performed when indicated by either transrectal ultrasound or digital rectal examination. The overall cancer detection rate for the four year period was 6.3 percent. A 3:1 cancer detection advantage of transrectal ultrasound over digital rectal examination was shown. Transrectal ultrasound and prostate-specific antigen each detected 92 percent of the proven cancers, and were complementary when either test was normal, together detecting 100 percent of the cancers. Thirty two percent (8/25) of all cancers were detected by digital examination, with digital exam having no predictive power after two study years. Prostate-specific antigen as an initial screening test for early prostate cancer may identify a suspicious group, whom may further be evaluated by transrectal ultrasound and digital exam. Results of this study lend credibility to the large scale randomized screening study proposed by the U.S. National Institutes of Health in which prostate-specific antigen and digital rectal examination are to be used as initial tests for prostate cancer detection.

A study was undertaken to assess the ability of transrectal ultrasound (TR/US), digital rectal examination (DRE), and Prostate Specific Antigen (PSA), to diagnose persistent prostate cancer following an I125 seed implant (SI). Twenty-six patients formed the study group. The median follow-up time was 38 months, and the range was 20 to 60 months. Eighty-eight percent (23/26) had suspicious lesions on TR/US, followed by ultrasound-guided biopsies. Biopsies were performed only on those patients having suspicious lesions on TR/US. Histologically proven adenocarcinoma was found in 81% (21/26) of the patients. Statistical evaluation was done using tissue obtained at biopsy as the "gold standard." The sensitivities for the DRE and PSA were 33% and 76%, respectively. The specificities for DRE and PSA were 50% and 0%, respectively. The positive predictive values for cancer were 91% by TR/US, 100% by DRE, and 89% by PSA. The negative predictive values were 13% for DRE and 0% for PSA. Overall detection rates (N = 26) were 81% for TR/US, 27% for DRE, and 62% for PSA. We conclude that ultrasound criteria for the presence of cancer are the same for both the post-irradiated prostate and the untreated prostate, and that TR/US is the most sensitive test for the diagnosis of persistent local cancer following I125 seed implantation.