Digital rectal examination in primary care is important for early detection of prostate cancer: a retrospective cohort analysis study

Abstract

Lynch and Rustom P Manecksha Research Abstract BackgroundCurrently, there is no standardised screening for prostate cancer in Europe. Assessment of risk is opportunistically undertaken in consultation with the GP or urologist. Evaluation of the prostate gland consists of a prostate-specific antigen (PSA) serum level and a digital rectal examination (DRE) of the gland. DRE is an essential part of the assessment that can independently predict prostate cancer in the setting of a normal PSA level. AimTo evaluate the clinical usefulness of the DRE in general practice and urology clinics, and to ascertain its positive predictive value and sensitivity. Design and settingA retrospective analysis study of a cohort of Irish men who underwent TRUS guided biopsy of the prostate in a single Irish tertiary referral centre, despite a normal PSA level. Patients were identified from a Rapid Access Prostate Clinic patient database. Pathological biopsy results were correlated with clinical DRE findings. MethodPatient demographics, PSA levels, and DRE findings from a prospectively established database and hospital data systems from May 2009 to October 2013 were analysed. ResultsOf 103 men referred over a 53-month period with a normal age-adjusted PSA level, 67% were referred on the basis of an abnormal DRE alone. Thirty-five per cent of males with a normal PSA had prostate cancer. DRE alone had a sensitivity and specificity of 81% and 40% respectively in diagnosing prostate cancer, with a positive predictive value of 42%. Seventy-six per cent of these men had high-grade disease. ConclusionDRE is a key part of the assessment for prostate cancer. It can independently identify patients at risk of prostate cancer, with a substantial proportion of these having clinically significant disease requiring treatment. This study reinforces the importance of DRE in the primary care setting in the assessment for prostate cancer. An abnormal DRE, even in the setting of a normal PSA level, necessitates referral.

A finger or not? Prostate examinations by non-urologists at a South African academic institution

“…[9] However, such doctors may not have the time to do routine screening owing to large patient loads and minimal time allowed with each patient. In overcrowded casualty settings, doctors may also not have the appropriate privacy for intimate examinations.…”

Assessment of Tumor Stiffness With Shear Wave Elastography in a Human Prostate Cancer Xenograft Implantation Model

“…It is well known that digital rectal examination is the oldest and least‐invasive test for the diagnosis of prostate cancer. It is based on the crucial factor that prostate cancer tissue is stiffer than normal prostate tissue . In recent years, imaging had played an important role in the detection of prostate cancer.…”

“…It is based on the crucial factor that prostate cancer tissue is stiffer than normal prostate tissue. 21,22 In recent years, imaging had played an important role in the detection of prostate cancer. Elastography as one of the novel imaging technologies that can distinguish tissue stiffness in real time.…”

Direct mechanical characterization of prostate tissue—a systematic review

“…The use of DRE is currently advocated in the main guidelines for the diagnosis of prostate cancer. There are, however, well‐published inter‐ and intra‐observer variability with DRE results, with specificity of the examination for prostate cancer as low as 40% . Neither a positive nor negative DRE test result is sufficient to enable a conclusive diagnosis without further evaluation .…”