effects of treatment overall and within subgroups of baseline prostate-specific antigen (PSA) and plasma selenium concentrations were examined using incidence rate ratios and Cox proportional hazards models. RESULTSSS continued to significantly reduce the overall incidence (relative risk and 95% confidence interval) of prostate cancer (0.51, 0.29-0.87). The protective effect of SS appeared to be confined to those with a baseline PSA level of £ 4 ng/mL (0.35, 0.13-0.87), although the interaction of baseline PSA and treatment was not statistically significant. Participants with baseline plasma selenium concentrations only in the lowest two tertiles (< 123.2 ng/mL) had significant reductions in prostate cancer incidence. A significant interaction between baseline plasma selenium and treatment was detected. CONCLUSIONTo the end of the blinded treatment the NPC trial continued to show a significant protective effect of SS on the overall incidence of prostate cancer, although the effect was restricted to those with lower baseline PSA and plasma selenium concentrations.

Objective  To test if supplemental dietary selenium is associated with changes in the incidence of prostate cancer. Patients and method  A total of 974 men with a history of either a basal cell or squamous cell carcinoma were randomized to either a daily supplement of 200 μg of selenium or a placebo. Patients were treated for a mean of 4.5 years and followed for a mean of 6.5 years. Results  Selenium treatment was associated with a significant (63%) reduction in the secondary endpoint of prostate cancer incidence during 1983–93. There were 13 prostate cancer cases in the selenium‐treated group and 35 cases in the placebo group (relative risk, RR=0.37, P=0.002). Restricting the analysis to the 843 patients with initially normal levels of prostate‐specific antigen (≤4 ng/mL), only four cases were diagnosed in the selenium‐treated group and 16 cases were diagnosed in the placebo group after a 2 year treatment lag, (RR=0.26 P=0.009). There were significant health benefits also for the other secondary endpoints of total cancer mortality, and the incidence of total, lung and colorectal cancer. There was no significant change in incidence for the primary endpoints of basal and squamous cell carcinoma of the skin. In light of these results, the ‘blinded’ phase of this trial was stopped early. Conclusions  Although selenium shows no protective effects against the primary endpoint of squamous and basal cell carcinomas of the skin, the selenium‐treated group had substantial reductions in the incidence of prostate cancer, and total cancer incidence and mortality that demand further evaluation in well‐controlled prevention trials.

OBJECTIVE To determine the potential risk of biopsy‐selected nerve‐sparing surgery based on the findings of site‐specific extracapsular extension (ECE) and positive surgical margins (PSMs) in the area of the neurovascular bundle in radical prostatectomy specimens. PATIENTS AND METHODS Controlling for surgical technique and pathological interpretation, 221 consecutive patients had their neurovascular bundles removed on the side with a positive biopsy. The surgical specimens were reviewed for ECE and PSM status, specifically in the area of the neurovascular bundle, from apex to base. RESULTS Of the 221 patients, 38% had ECE and 43 (20%) had a PSM in the area of the neurovascular bundle. This equates to a ratio of 51% for PSM/ECE. An additional 42 men (18%) had ECE with negative margins, but would have been at potential risk for PSMs if the neurovascular bundle had been preserved. CONCLUSION Preserving the neurovascular bundle on the side with a positive biopsy could result in a significantly greater incidence of PSM than with wide excision. Optimizing cancer control may require excision of the neurovascular bundle on a side known to have cancer on biopsy. In future site‐specific analyses, the PSM/ECE ratio could be used as a marker comparing cancer‐control outcomes from studies with differing technical approaches and indications for nerve‐sparing surgery.

Objective To compare the rates of cancer detection in menResults On comparing groups with suspicious and normal DREs, and abnormal with normal PSA levels with a normal, asymmetric, or suspicious prostate on digital rectal examination (DRE) initially and after 3 years both, as expected, were associated with a statistically significant increase in cancer detection. However, an of serial monitoring of prostate specific antigen (PSA) level. Patients and methods Prostatic 'asymmetry' was defined asymmetric prostate did not carry an increased risk of detecting prostate cancer when compared with a as asymmetric growth of the lateral lobes of the prostate without induration or nodules, as assessed by normal prostate, regardless of PSA level. Conclusions An asymmetric prostate does not appear to a DRE. The study included 963 men with no clinical evidence of prostate cancer and whose serum PSA be an independent risk factor for detecting prostate cancer. Therefore, an asymmetric prostate with no levels were monitored at 4 month intervals. Prostatic biopsy was recommended if the PSA level became abnormality in PSA level should not mandate prostatic biopsy, or even an increase in monitoring frequency persistently abnormal (>4ng/mL) or increased by >20% after having been initially abnormal. Cancer above the presently recommended annual interval. Keywords Prostate cancer, digital rectal examination, detection rates were compared among groups categorized by the initial DRE findings and serum PSA level.asymmetry, prostate specific antigen the prognosis of patients with an asymmetric prostate. ToIntroduction investigate this, we compared cancer detection rates in a study of serial PSA monitoring among men with DREs Previously, the detection of prostate cancer relied mainly on a DRE carried out by an experienced urologist.that were normal, asymmetric or suspicious. Recently, PSA has been accepted as a screening method for prostate cancer in men and has improved cancer Patients and methods detection rates, as well as increasing the detection of organ-confined disease [1]. Many studies have analysed Between September 1991 and September 1992, 1028 healthy male volunteers over the age of 50 years were cancer detection rates based on the DRE and PSA level; recently, Catalona et al. [2] showed that the combination enrolled into a prostate cancer detection study using a DRE and serum PSA level as the detection methods. Men of PSA and DRE enhanced the detection rate of organconfined cancer by 78%. In that study, and in many with either a non-suspicious DRE (normal or asymmetric) and a normal PSA level, or an abnormality in DRE others, the DRE findings were defined as suspicious or not suspicious; a suspicious DRE was defined as an induration, (induration or nodule) or PSA level (> 4 ng/mL) with a negative prostatic biopsy were oÂered entry into a asymmetry or nodule. In other studies, e.g. [3], the DRE findings were defined as suspicious (induration or nodule), study of serial PSA monitoring. A normal DRE was defined as a soft gland with...