Approximately 10% of the patients undergoing simple prostatectomy for presumed benign disease have clinically unsuspected prostatic carcinoma. In these patients curative treatment, such as radical prostatectomy and some forms of radiation therapy, often are compromissed by the simple prostatectomy. To determine whether routine prostatic needle biopsy would be practical to identity patients with occult carcinoma a prospective study has been initiated of routine needle biopsy in patients more than 50 years old referred for urologic evaluation. To date 71 consecutive patients have been biopsied, 21 of whom underwent subsequent simple prostatectomy after negative needle biopsy. Carcinoma was found in none of 24 men not having prostatic induration, 4 of 36 (11%) with minimal induration and 5 of 11 (45%) with marked induration. The results indicate that the vast majority of the patients with prostatic carcinomas has some degree of palpable induration and that a high index of suspicion appears warranted when any prostatic induration is present on digital rectal examination.
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