Which of the following statement(s) are true concerning the detection and diagnosis of prostatic cancer?

b. American blacks have an increased risk of prostatic carcinoma

c. Autopsy series would suggest that 10% of men in their 50’s will have small latent prostatic cancers

d. Transrectal prostatic biopsy is indicated for a palpable 1 cm prostate nodule

Adenocarcinoma of the prostate is the most common non-cutaneous malignant tumor in men, accounting for 20% of all male cancers and is the second highest cause of cancer deaths in males. It is primarily a disease of older men. At autopsy, about 10% of men in their 50’s can be shown to have small latent tumors, and with this number increasing to 70% of men in their 80’s. However, it is estimated that only 10% of men over 65 will develop clinically significant prostate cancer. An increased incidence in American blacks has been reported.

Early prostate cancer has few symptoms. Therefore, early diagnosis requires detection of small tumors within the prostate gland. Three modalities are used in the early detection of prostate cancer. These include digital rectal examination, serum prostate specific antigen (PSA), and transrectal ultrasound of the prostate. Prostate tumors usually arise in the posterior lobe of the prostate an area readily palpable on digital rectal examination. Early prostatic cancer frequently presents as a small firm nodule within or at the periphery of the gland. If a 1 cm nodule is detected, it is cancer about 50% of the time. Prostatic biopsy is readily performed with little morbidity and is often required to confirm the diagnosis. Transrectal ultrasound of the prostate may also detect prostate cancer often as a smaller more subtle lesion not easily discernable on rectal examination. However, digital examination will also disclose some cancers that are not visualized with ultrasound. Serum PSA is used to aid in the early detection of prostate cancer. PSA is elevated in 68% of men with cancer but 33% of men with benign enlargement of the gland also have an enlarged PSA. Serum prostatic acid phosphatase is not specific for prostatic cancer although a significant elevation is usually associated with metastatic disease. Serum acid phosphatase however has been generally replaced as a tumor marker by the immunoassay for PSA. PSA is also an extremely sensitive tumor marker for recurrences after surgery because serum levels should be undetectable if patients are tumor-free.