Jae Mann Song, et al. Reducing the PSA cutoff point from 10 ng/mL to 4 ng/mL can increase the sensitivity, but doing so will further reduce the specificity. Also, the DRE as a time-honored method of diagnosis may show false negative and positive results.49 TRUS is not highly accurate for staging prostate cancer, and it has an overall reported accuracy of only 58%.50 The American College of Preventive Medicine (ACPM),51 the American Urological Association (AUA),52 the Singapore Ministry of Health (MOH),53 the American Cancer Society (ACS),54 and the U.S. Preventive Services Task Force (USPSTF)55 have recently presented their recom- mendations for screening men for prostate cancer along with the explicit reasoning behind their judgment. Among these five groups, the guide- lines from the Singapore MOH and AUA pro- vided recommendations for the diagnosis, treat- ment and management of prostate cancer in addi- tion to their screening recommendations for this disease. Men aged 50 or older with a life expec- tancy of greater than 10 years should be given in- formation about the potential benefits and harms of screening for prostate cancer. Although there is agreement among all the groups on the use of PSA and DRE as the primary screening tests for prostate cancer, the AUA, Singapore MOH and ACS explicitly recommend combining the two tests to improve accuracy. Further, the use of TRUS as a screening test for prostate cancer is no longer considered valid by the ACPM or USPSTF, and the AUA recommends against it. Similarly, the Singapore MOH does not address TRUS as a screening test, but rather, it is considered in com- bination with biopsy for diagnostic purposes.56 In conclusion, urologists should take the char- acteristics of the diagnostic triad (PSA, DRE and TRUS) and the outcomes of meta-analysis (pooled sensitivity and specificity, the estimates of d̅) into consideration. They should use these methods as a combination rather than separately imple- menting these methods for the primary diagnosis of prostate cancer in men with lower urological symptoms. REFERENCES 1. Troyer DA, Mubiru J, Leach RJ, Naylor SL. Promise Yonsei Med J Vol. 46, No. 3, 2005 and challenge: Markers of prostate cancer detection, diagnosis and prognosis. Dis Markers 2004;20:117-28. 2. Kataja VV. ESMO Guidelines Task Force. ESMO Mini- mum clinical recommendations for diagnosis, treatment and follow-up of prostate cancer. Ann Oncol 2003;14: 1010-1. 3. Cheon J, Kim CS, Lee ES, Hong SJ, Cho YH, Shin EC, et al. Survey of incidence of urological cancer in South Korea: A 15-year summary. Int J Urol 2002;9:445-54. 4. Whittemore AS, Kolonel LN, Wu AH, John EM, Gallagher RP, Howe GR, et al. Prostate cancer in rela- tion to diet, physical activity, and body size in blacks, whites, and Asians in the United States and Canada. J Natl Cancer Inst 1995;87:652-61. 5. Kolonel LN, Nomura AM, Cooney RV. Dietary fat and prostate cancer: Current status. J Natl Cancer Inst 1999; 91:414-28. 6. Mettlin C, Jones GW, Murphy GP. Trends in prostate cancer care in the United States, 1974-1990: Observa- tions from the patient care evaluation studies of the American College of Surgeons Commission on Cancer. CA Cancer J Clin 1993;43:83-91. 7. Engelbrecht MR, Jager GJ, Laheij RJ, Verbeek AL, van Lier HJ, Barentsz JO. Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis. Eur Radiol 2002;12:2294-302. 8. Cazares LH, Adam BL, Ward MD, Nasim S, Schellhammer PF, Semmes OJ, et al. Normal, benign, preneoplastic, and malignant prostate cells have dis- tinct protein expression profiles resolved by surface enhanced laser desorption/ionization mass spectro- metry. Clin Cancer Res 2002;8:2541-52. 9. Best CJ, Leiva IM, Chuaqui RF, Gillespie JW, Duray PH, Murgai M, et al. Molecular differentiation of high- and moderate-grade human prostate cancer by cDNA microarray analysis. Diagn Mol Pathol 2003;12:63-70. 10. Hernandez J, Thompson IM. Prostate-specific antigen: A review of the validation of the most commonly used cancer biomarker. Cancer 2004;101:894-904. 11. Ablin RJ, Bronson P, Soanes WA, Witebsky E. Tissue- and species-specific antigens of normal human prosta- tic tissue. J Immunol 1970;104:1329-39. 12. Wang MC, Valenzuela LA, Murphy GP, Chu TM. Puri- fication of a human prostate specific antigen. Invest Urol 1979;17:159-63. 13. Kang JH, Kim CI, Lee SJ. Clinical usefulness of pros- tatic acid phosphatase in prostate cancer: A compara- tive study with prostate specific antigen. Korean J Inf Dis 1982;38:1183-9. 14. Watanabe H, Igari D, Tanahashi Y, Harada K, Saitoh M. Transrectal ultrasonography of the prostate. J Urol 1975;114:734-9. 15. Kim ND, Kwon SW. Suprapubic ultrasonographic findings of the prostatic diseases. Korean J Urol 1982; 23:479-86. 16. Aziz DC, Barathur RB. Prostate-specific antigen and prostate volume: A meta-analysis of prostate cancer screening criteria. J Clin Lab Anal 1993;7:283-92.