13 Estimation of Clinically Relevant Prostate Volumes by Digital Rectal Examination-a Comparative Study

Ahmad, Sarwat; Manecksha, R.P.; Cullen, I.M.; McDermott, Ted; Flynn, Robert; Grainger, Ronald G.; Thornhill, John

doi:10.1016/s1569-9056(11)60018-3

Cited by 8 publications

(15 citation statements)

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“…There have been several reports about the comparison of the PV with DRE directly, but the accuracy of the subjective impression of DRE in the five-grade evaluation that urologists carry out daily has not been reported. [10][11][12] We believe that the present results are more realistic with regard to clinical practice than those of other reports.…”

Section: Discussionsupporting

confidence: 65%

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Does digital rectal examination predict prostate volume greater than 30 mL?

2017

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Abbreviations & Acronyms BPH = benign prostatic hyperplasia DRE = digital rectal examination F = flat LUTS = lower urinary tract symptoms LUTS/BPH = lower urinary tract symptoms suggestive of benign prostatic hyperplasia Ma = markedly enlarged Mo = moderately enlarged N = normal PV = prostate volume S = slightly enlarged TRUS = transrectal ultrasound Objectives: To investigate the accuracy of digital rectal examination in estimating prostate volume in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Methods: A community-based study was carried out in Japan to investigate the prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia. A total of 457 men were screened and deemed eligible for the present analysis. Findings on digital rectal examination were compared with prostate volume measurement by transrectal ultrasound. Five groups were identified on digital rectal examination: flat, normal, slightly enlarged, moderately enlarged and markedly enlarged. Results: The median age and prostate volume were 64 years and 19.7 mL, respectively. Prostate volumes for the flat, normal, slightly enlarged, moderately enlarged, and markedly enlarged groups were 16.4, 18.3, 27.0, 41.9 and 86.3 mL, respectively. There were significant differences in prostate volume between the groups. The positive predictive value was 94.1% if flat, and normal were assumed to have a prostate volume <30 mL. The value was 80.8% if moderately enlarged, and markedly enlarged were assumed to have a prostate volume ≥30 mL. Of the men in the slightly enlarged group, 61.0% had a prostate volume <30 mL. Conclusions: It is possible to stratify prostate volume according to digital rectal examination. We could determine the prostates in the flat and normal groups to have a prostate volume <30 mL, and those in the moderately enlarged and markedly enlarged groups to have a prostate volume ≥30 mL by digital rectal examination with high accuracy. Transrectal ultrasound was required for those in the slightly enlarged group.

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Section: Discussionsupporting

confidence: 65%

“…Previous studies have reported the sensitivity and specificity of DRE to predict PV. [10][11][12][13] Bosch et al reported that the sensitivity and specificity of the PV 30 mL cut-off level were 94.3% and 78.2%, respectively. In contrast, Michael et al reported that these values were 39.8% and 81.6%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Does digital rectal examination predict prostate volume greater than 30 mL?

2017

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“…Bosch et al have shown that prostate volume estimation between 30 and 50 cc on DRE may be an acceptable method for monitoring in case of not available ultrasonography, given the good accuracy of the method in this range [4]. Recently, Ahmad et al demonstrated that ultrasound would be required for volumes less than 30 cc or above 80 cc, while DRE has positive predictive value of 94% to identify prostates above 30 cc, a clinically significant indication of 5-alpha reductase inhibitors [17]. In our experience with DRE standardization, even for inexperienced hands, 92% patients (24 of 26 cases) were accurately estimated on DRE for clinical relevant prostate volumes (>30 cc), standing at a very little distance from ultrasonography findings when excluding outliers in ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Digital Rectal Examination Standardization for Inexperienced Hands: Teaching Medical Students

Reis

Simão

Baracat

et al. 2013

Advances in Urology

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Objectives. To standardize digital rectal examination (DRE) and set how it correlates with the comprehensive evaluation of lower urinary tract symptoms (LUTS). Methods. After scaled standardization of DRE based on fingertips graphical schema: 10 cubic centimeters—cc for each fingertip prostate surface area on DRE, four randomly selected senior medical students examined 48 male patients presenting with LUTS in an outpatient clinical setting, totaling 12 DRE each. Standardized DRE, international prostate symptom score (IPSS), serum PSA, transabdominal ultrasound (US), urodynamic evaluation, and postvoid residue were compared. Results. The mean and median PVs were US—45 and 34.7 cc (5.5 to 155) and DRE—39 and 37.5 cc (15 to 80). Comparing DRE and US by simple linear regression: US PV = 11.93 + 0.85 × (DRE PV); P = 0.0009. Among patients classified as nonobstructed, inconclusive, and obstructed, the US PVs were 29.8, 43.2, and 53.6 cc (P = 0.033), and DRE PVs were 20, 35, and 60 cc (P = 0.026), respectively. Conclusion. This is the first attempt to DRE standardization focusing on teaching-learning process, establishing a linear correlation of DRE and US PVs with only 12 examinations by inexperienced hands, satisfactorily validated in an outpatient clinical setting.

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“…Ahmad et al [9] concluded that digital rectal examination (DRE) usually underestimates the prostate volume compared to TRUS, but it is an accurate tool…”

Section: Review Of Literaturementioning

confidence: 99%

“…In addition, DRE estimation in patients with BMI over 30 is less accurate too [9]. This is adequate for clinical purposes like starting 5ARIs.…”

Section: Key Pointsmentioning

confidence: 99%