SCREENING FOR CARCINOMA OF THE PROSTATE BY DIGITAL RECTAL EXAMINATION IN A RANDOMLY SELECTED POPULATION

Objective - To study the acceptability, costs, psychosocial consequences, and organisation of screening for carcinoma of the prostate. Design - A randomly selected population was personally invited for digital rectal examination by a urologist and a general practitioner. Further examinations were performed if induration was felt. Each man completed a questionnaire on his response to the examination. Setting - General practices in the area of Norrkoping. Patients - 1494 Men aged 50-69 randomly selected from a population of 9026. Main outcome measure - Prostates having a firm nodular consistency. Results - Carcinoma of the prostate was suspected in 45 of 1163 patients examined; in 10 by the general practitioners, in 10 by the urologists, and in 25 by both. Forty four men had a fine needle aspiration biopsy, and carcinomas were found in 13 cases. Of these, one had been suspected by the general practitioner, four by urologists, and eight by both. The cost for each man was £11.60, and the cost for each case of carcinoma detected and treated by potentially curative methods was $2477. Of the 13 men with carcinoma, 10 underwent radical prostatectomy and one radiotherapy. One man had advanced disease and was given endocrine treatment, another was not treated. Only 193 men felt distress during the initial examination. Of the 44 men who had an aspiration biopsy, 25 experienced anxiety. Conclusions - Screening for carcinoma of the prostate by a urologist or a general practitioner using digital rectal examination is a cost effective method of early diagnosis. Whether such screening leads to prolonged survival, however, remains doubtful.