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 OJU  Vol.1 No.4 , November 2011
The Performance of Abnormal Digital Rectal Examination for the Detection of Prostate Cancer at Stratified Prostate Specific Antigen Levels
Abstract: Objective: Our aim was to determine the performance of abnormal digital rectal examination (DRE) in prostate cancer detection at different PSA levels. Methods: A total of 1612 patients having abnormal DRE and/or elevated PSA whom underwent TRUS guided prostate biopsies were included in the study. Any palpable induration or nodularity was accepted as abnormal DRE findings. Pathologic features of biopsy specimens were compared within groups according to DRE findings and serum PSA level groups of 2.5 - 4, 4 - 10 and >10 ng/ml. Results: Abnormal DRE was detected in 339 patients; of whom 48.7% were determined to have cancer. Cancer detection rates of patients having abnormal DRE were found to be 20%, 31.5% and 68% at PSA ranges 2.5-4, 4-10 and > 10 ng/ml, respectively. Significantly higher grade cancers were detected by abnormal DRE at each PSA group. The positive and negative predictive values of abnormal DRE according to groups of PSA 2.5 - 4, 4 - 10 and > 10 ng/ml were 20% and 84.1%, 31.5% and 80.6%, 68% and 66.6%, respectively. Conclusion: At each PSA group DRE resulted in detecting significantly more cancers with Gleason score > 7. Although predictive value of abnormal DRE diminishes with concomitantly decreasing PSA levels, significance of DRE in the diagnosis of prostate cancer cannot be ignored.
Cite this paper: nullG. Aslan, B. Irer, S. Cimen, Y. Goktay, I. Celebi, B. Tuna and K. Yorukoglu, "The Performance of Abnormal Digital Rectal Examination for the Detection of Prostate Cancer at Stratified Prostate Specific Antigen Levels," Open Journal of Urology, Vol. 1 No. 4, 2011, pp. 67-71. doi: 10.4236/oju.2011.14014.
References

[1]   S. H. Landis, T. Murray, S. Bolden and P. A. Wingo, “Cancer Statistics,” CA: A Cancer Journal for Clinicians, Vol. 48, No. 1, 1998, pp. 6-29. doi:10.3322/canjclin.48.1.6

[2]   S. J. Jacobsen, S. K. Katusic, E. J. Bergstralh, et al., “Incidence of Prostate Cancer Diagnosis in the Eras before and after Prostate-Specific Antigen Testing,” The Journal of the American Medical Association, Vol. 274, No. 18, 1995, pp. 1445-1449. doi:10.1001/jama.274.18.1445

[3]   D. S. Smith, P. A. Humphrey and W. J. Catalona, “The Early Detection of Prostate Carcinoma with Prostate Specific Antigen: The Washington University Experience,” Cancer, Vol. 80, No. 9, 1997, pp. 1852-1856. doi:10.1002/(SICI)1097-0142(19971101)80:9<1852::AID-CNCR25>3.3.CO;2-H

[4]   G. F. Carvalhal, D. S. Smith, D. E. Mager, C. Ramos and W. J. Catalona, “Digital Rectal Examination for detecting Prostate Cancer at Prostate Specific Antigen Levels of 4 ng/ml or Less,” Journal of Urology, Vol. 161, No. 3, 1999, pp. 835-839. doi:10.1016/S0022-5347(01)61785-3

[5]   J. L. Gore, S. F. Shariat, B. J. Miles, D. Kadmon, N. Jiang, T. M. Wheeler and K. M. Slawin, “Optimal Combinations of Systemic Sextant and Laterally Directed Biopsies for the Detection of Prostate Cancer,” Journal of Urology, Vol. 165, No. 5, 2001, pp. 1554-1559. doi:10.1016/S0022-5347(05)66347-1

[6]   K. Mistry and G. Cable, “Meta-Analysis of Prostate-Specific Antigen and Digital Rectal Examination as Screening Tests for Prostate Carcinoma,” The Journal of the American Board of Family Medicine, Vol. 16, 2003, No. 2, pp. 95-101. doi:10.3122/jabfm.16.2.95

[7]   R. O. Roberts, E. J. Bergstralh, M. M. Lieber and S. J. Jacobsen, “Digital Rectal Examination and Prostate-Specific Antigen Abnormalities at the Time of Prostate Biopsy and Biopsy Outcomes, 1980 to 1997,” Urology, Vol. 56, No. 5, 2000, pp. 817-822. doi:10.1016/S0090-4295(00)00790-1

[8]   T. Yamamoto, K. Ito, M. Ohi, et al., “Diagnostic Significance of Digital Rectal Examination and Transrectal Ultrasonography in Men with Prostate-Specific Antigen Levels of 4 ng/ml or Less,” Urology, Vol. 58, No. 6, 2001, pp. 994-998. doi:10.1016/S0090-4295(01)01409-1

[9]   J. E. Fowler, S. A. Bigler, P. B. Farabaugh and S. S. Wilson, “Prostate Cancer Detection in Black and White Men with Abnormal Digital Rectal Examination and Prostate Specific Antigen Less than 4 ng/ml,” Journal of Urology, Vol. 164, No. 6, 2000, pp. 1961-1963. doi:10.1016/S0022-5347(05)66928-5

[10]   W. J. Catalona, J. P. Richie, F. R. Ahmann, et al., “Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6630 Men,” Journal of Urology, Vol. 151, No. 5, 1994, pp. 1283-1290.

[11]   C. Gosselaar, M. J. Roobol, S. Roemeling, T. H. van der Kwast and F. H. Schroder, “Screening for Prostate Cancer at Low PSA Range: The Impact of Digital Rectal Examination on Tumor Incidence and Tumor Characteristics,” The Prostate, Vol. 67, No. 2, 2007, pp. 154-161. doi:10.1002/pros.20501

[12]   F. H. Schroder, M. Roobol-Bouts, A. N. Vis, T. van der Kwast and R. Kranse, “Prostate-Specific Antigen-Based Early Detection of Prostate Cancer-Validation of Screening without Rectal Examination,” Urology, Vol. 57, No. 1, 2001, pp. 83-90.

[13]   C. Gosselaar, M. J. Roobol, R. van den Bergh, T. Wolters and F. H. Schroder, “Digital Rectal Examination and the Diagnosis of Prostate Cancer—A Study Based on 8 Years and Three Screenings within the European Randomized Study of Screening for Prostate Cancer (ERSPC), Rotterdam,” European Urology, Vol. 55, No. 1, 2009, pp. 139-147. doi:10.1016/j.eururo.2008.03.079

[14]   P. M. Beemsterboer, R. Kranse, H. J. de Koning, J. D. Habbema and F. H. Schroder, “Changing Role of 3 Screening Modalities in the European Randomized Study of Screening for Prostate Cancer (Rotterdam),” International Journal of Cancer, Vol. 84, No. 4, 1999, pp. 437-441. doi:10.1002/(SICI)1097-0215(19990820)84:4<437::AID-IJC19>3.0.CO;2-S

[15]   O. T. Okotie, A. K. Roehl, M. Han, S. Loeb, S. N. Gashti and W. J. Catalona, “Characteristics of Prostate Cancer Detected by Digital Rectal Examination Only,” Urology, Vol. 70, No. 6, 2007, pp. 1117-1120. doi:10.1016/j.urology.2007.07.019

[16]   C. Gosselaar, M. J. Roobol, S. Roemeling and F. H. Schroder, “The Role of the Digital Rectal examination in Subsequent Screening Visits in the European Randomized Study of Screening for Prostate Cancer (ERSPC), Rotterdam,” European Urology, Vol. 54, No. 3, 2008, pp. 581-588. doi:10.1016/j.eururo.2008.03.104

[17]   M. I. Thompson, D. K. Pauler, P. J. Goodman, et al., “Prevalance of prostate cancer among men with a prostate-specific antigen level ≤ 4 ng per milliliter,” The New England Journal of Medicine, Vol. 350, No. 22, 2004, pp. 2239-2246. doi:10.1056/NEJMoa031918

 
 
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