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.