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 83% on subsequent examinations and (P.35). Grade distribution of tumors was similar in both groups. Overall 5 and 10 year survival of all cancer patients was 85% and 67%, respectively. Death from prostate cancer was 8% (3/38) in men diagnosed on initial examination and 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 [corrected].