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May 13, 1998

Detection of Early Prostate Cancer: Serendipitous or Systematic?

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(18):1439-1441. doi:10.1001/jama.279.18.1439

To the Editor.—Dr McNaughton Collins and colleagues1postulate a role for serendipity in prostate cancer detection. We concur that a cancer detected based on elevated prostate-specific antigen (PSA) concentration is "serendipitous" if the diagnosis is followed by prostatectomy in which minimal (<0.5 cm3) cancer is found. However, detection of cancer after abnormal digital rectal examination (DRE) may be less serendipitous than the authors imply. Their definition is valid for DRE only if one relies on clinical incidence data since it is not also based on the "gold standard" of prostatectomy or autopsy findings. They state that in 28% of cases, cancer on quadrant needle biopsy is identified only in a site different from the abnormal DRE findings. This 28% "false-positive" rate for DRE, presumably resulting from hyperplasia or prostatitis, would probably be lower if the authors had relied on matched prostatectomies, but is inflated by the inherent high false-negative rate of biopsy sampling; cancer present in the abnormal site is easily missed.

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