Abstract
a fi p L b s p i rostate cancer is a major medical and socioeconomic problem. Prostate cancer is the most common noncutaeous cancer and the second most common cause of cancer eath in American men. The 2007 report from the American ancer Society projected 218,890 new cases of prostate caner and 27,050 additional deaths due to the disease in the nited States.1 It is anticipated that the aging population will ead to increases in prostate cancer incidence. Screening for prostate cancer involves digital rectal examnation (DRE), assessment of the prostate-specific antigen PSA) level in serum, and transrectal ultrasonography TRUS) with biopsy. In about 14% of men with prostate ancer, diagnosis can be established on the basis of DRE lone.2 Challenges for the DRE include interexaminer varibility in DRE findings, which has been shown to occur irrepective of experience level,3 and the fact that only peripheral one tumors can be palpated transrectally. Studies have hown that DRE is still important in diagnosing clinically mportant prostate cancer and continues to provide imporant prognostic information.4,5 The most widely used and available test to detect prostate ancer is the measurement of serum PSA. Disease incidence, tage at presentation, and 5-year survival rates have imroved significantly in the last 20 years following the introuction of PSA testing, which led to widespread screening for rostate cancer worldwide. Although elevated PSA levels can e suggestive of malignancy, benign conditions such as beign prostatic hyperplasia or prostatitis can also lead to PSA levation.6 It was demonstrated that only 25 to 40% of men ith PSA above the 4.0 ng/mL threshold will be diagnosed ith cancer, leading to about 60 to 75% of men in the PSA ange 4.0 to 10 ng/mL undergoing an unnecessary biopsy.7 bout 15% of men over the age of 60 have prostate cancer
Published Version
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