DISEASE-SPECIFIC SURVIVAL FOLLOWING ROUTINE PROSTATE-CANCER SCREENING BY DIGITAL RECTAL EXAMINATION

Objective.-To assess prostate cancer mortality in men undergoing routine screening by routine digital rectal examination. Design.-Cohort study with a median follow-up period of 75 months. Setting.-Population consisted of volunteers at a university clinic and men in an institutional health maintenance clinic. Patients.-Fifty-six men with a mean age of 65 years (range, 52 to 79 years) diagnosed with prostate cancer. Interventions.-Patients treated initially by observation, external or interstitial radiotherapy, radical prostatectomy, hormone therapy, or combination. Main Outcome Measures.-Kaplan-Meier analysis of time to local progression, distant metastases, death from all causes, and death from prostate cancer. Mantel-Haenszel log-rank statistic was used to compare outcome in men diagnosed on initial examination with those diagnosed on subsequent examinations. Results.-Clinically localized prostate cancer was diagnosed in 73% during an initial examination and in 33% (6/18) during subsequent examinations. Five- and 10-year disease-specific survival was 97% and 86%, respectively, for men diagnosed during the first rectal examination compared with only 81% and 57%, respectively, for men diagnosed on subsequent rectal examinations (P=.02). Conclusion.-Routine screening for prostate cancer by annual digital rectal examination alone may be insufficiently frequent and/or sensitive to prevent significant mortality from this disease.