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Transrectal ultrasound (TRUS) is becoming more widely used as a method of investigating prostatic disease. This study investigated the acceptance of this technique in 89 patients undergoing evaluation for suspected malignant disease. The true morbidity associated with TRUS and TRUS-guided biopsy was evaluated. Serious complications were rare, but minor complications were frequent. Careful counselling is recommended prior to the procedure in order to minimise the patients' anxiety and ensure that if complications do occur they are dealt with swiftly and appropriately.

The relationship between prostate specific antigen (PSA) levels, prostate volume and age was examined in 472 men who underwent PSA assay (Hybritech), digital rectal examination (DRE) and transrectal ultrasound (TRUS) as part of a community survey of benign prostatic hyperplasia following exclusion of men with prostate cancer. The mean age of the study population was 60 years (range 40-79). The mean PSA was 2.4 ng/ml and 85% of the men had levels < 4 ng/ml. There was a modest correlation between PSA and both age and prostate volume. The mean prostate and adenoma volumes were 32 ml (SD 13.4) and 15 ml (SD 10.7) respectively. Prostate volume increased with age. Linear regression analysis revealed an independent association between PSA and age when controlling for volume. The mean ratio of PSA per unit of prostate volume was 0.072 ng/ml. This ratio also increased with age. Age and prostate volume influences PSA levels independently. The sensitivity and specificity of PSA adjusted for volume and age in the diagnosis of prostate cancer need to be evaluated in association with DRE and TRUS.

Study Type – Preference (prospective cohort)
Level of Evidence 1b What’s known on the subject? and What does the study add? In general the literature suggests that there is a need for improvement in aiding men diagnosed with early prostate cancer in their decision making about treatment options and that our understanding of this process is inadequate. There is limited data analyzing the reasons why these men decide between potentially curative or observational treatments and data evaluating patients’ views before and after definitive therapy are scarce. This study begins the process of understanding the reasons underlying a patient’s final treatment decision. Being a prospective study, it looks at the thought processes of these men before treatment during the time the decision is made. It also documents how satisfied patients are with their choice after their treatment and whether they would choose the same treatment again. OBJECTIVE • To identify the reasons for patients with localised prostate cancer choosing between treatments and the relationship of procedure type to patient satisfaction post‐treatment. PATIENTS AND METHODS • 768 men with prostate cancer (stage T1/2, Gleason ≤7, PSA <20 ug/L) chose between four treatments: radical prostatectomy, brachytherapy, conformal radiotherapy and active surveillance. • Prior to choosing, patients were counselled by a urological surgeon, clinical (radiation) oncologist and uro‐oncology specialist nurse. • Pre‐treatment reasons for choice were recorded. Post‐treatment satisfaction was examined via postal questionnaire. RESULTS • Of the 768 patients, 305 (40%) chose surgery, 237 (31%) conformal beam radiotherapy, 165 (21%) brachytherapy and 61 (8%) active surveillance. • Sixty percent of men who opted for radical prostatectomy were motivated by the need for physical removal of the cancer. • Conformal radiotherapy was mainly chosen by patients who feared other treatments (n = 63, 27%). Most men chose brachytherapy because it was more convenient for their lifestyle (n = 64, 39%). • Active surveillance was chosen by patients for more varied reasons. Post‐treatment satisfaction was assessed in a subgroup who took part in the QOL aspect of this study. • Of the respondents to the questionnaire, 212(87.6%) stated that they were satisfied/extremely satisfied with their choice and 171(92.9%) indicated they would choose the same treatment again. CONCLUSION • Men with early prostate cancer have clear reasons for making decisions about treatment. Overall, patients were satisfied with the treatment and indicated that despite different reasons for choosing treatment, they would make the same choice again.

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