Prospective evaluation on the effect of interobserver variability of digital rectal examination on the performance of the Rotterdam Prostate Cancer Risk Calculator

Pereira-Azevedo, Nuno; Braga, Isaac Campos; Verbeek, Jan; Osório, Luís; Cavadas, Vítor; Fraga, Avelino; Carrasquinho, Eduardo; Oliveira, Eduardo Cardoso de; Nieboer, Daan; Roobol, Monique J.

doi:10.1111/iju.13442

Cited by 10 publications

(5 citation statements)

References 25 publications

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“…The summary data for these studies are presented in Table 2, in chronological order. 5,12,13,[24][25][26][27][28][29] Several studies have indicated that that there was a tendency for DRE to over or underestimate the reference PGV, such that the estimation of the PGV by DRE was most accurate when the PGV was close to the median value of the reference PGV for the patients in those studies. DRE tended to overestimate the PGV when the PGV was smaller than the median reference value and tended to underestimate the PGV when it was larger.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the accuracy of the digital rectal examination as a method of measuring prostate gland volume

Christie

Windsor²,

Sharpley

2019

Journal of Clinical Urology

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Objective: There are many important clinical scenarios in which estimates of the volume of the prostate gland can have an influence on clinical decisions. The digital rectal examination is the simplest and most readily available method for measuring it. It is commonly performed numerous times every day by practising urologists and radiation oncologists. The prostate gland volume is the most studied parameter arising from it. Although reported in many heterogeneous studies, the accuracy of the digital rectal examination in measuring the volume has never been reviewed. Our aim was to conduct the world’s first systematic review. Methods: Articles from the literature were included if they compared the digital rectal examination with more accurate measures including fluid displacement after radical prostatectomy and transrectal ultrasound measurements. Results: Nineteen articles describing 7891 patients were reviewed and summarised. Wide variations were noted but most studies provided correlation coefficients that lay between 0.3 and 0.7. For those studies that did not involve special training in volume estimation or were not conducted by a urologist with a special interest in the correlation, the coefficients were below 0.6. For eight studies that analysed the estimated volume as a categorical variable, concordance was described using a variety of statistical tests but was generally high. Conclusions: The reported correlations were weak to moderate strength indicating that the digital rectal examination may not be accurate enough when quantitative measurements are required. However, enlargement of the prostate was detectable with high levels of concordance, indicating that the digital rectal examination is effective for that purpose. Level of evidence: Not applicable for this multicentre audit.

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Section: Resultsmentioning

confidence: 99%

A systematic review of the accuracy of the digital rectal examination as a method of measuring prostate gland volume

Christie

Windsor²,

Sharpley

2019

Journal of Clinical Urology

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“…To the best of our knowledge, no literature concerning the interrater agreement of DRE has been published. Interrater agreement has only been studied in vaginal digital assessment concerning the pelvic floor function and digital rectal examination in the context of prostate cancer [31][32][33]. Overall, the agreement was substantial to almost perfect.…”

Section: Discussionmentioning

confidence: 99%

To what extent are anorectal function tests comparable? A study comparing digital rectal examination, anal electromyography, 3-dimensional high-resolution anal manometry, and transperineal ultrasound

Dekker

Reijn-Baggen

Han-Geurts

et al. 2023

Int J Colorectal Dis

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Background Anorectal function tests are helpful for objective investigation of anorectal (dys)function. A variety of tests are available, but there is no recommendation when to perform which test. Furthermore, which test is the most accurate is controversial and the correlation between these tests is not very clear. The aim of our study was to examine the correlation of anal pressures and the possibility to diagnose pelvic floor dyssynergia between digital rectal examination (DRE) and several anorectal function tests. Methods Between January 2020 and April 2022, all men and women aged 18 to 80 years, treated at the Proctos Clinic, who were referred for pelvic floor physical therapy (PFPT) by the surgeon and underwent anorectal function tests, were included. DRE was performed to establish the anal pressure at rest and during squeeze and straining. Anorectal function tests included 3D high-resolution anal manometry (3D-HRAM), balloon expulsion test (BET), transperineal ultrasound (TPUS), and surface electromyography (s-EMG). Results A total of 50 patients, 37 (74%) females, were included. Median age was 51 years. Twenty-three (62%) females had a history of two or more vaginal deliveries. The most frequent reason for referral for PFPT was fecal incontinence in 27 (54%) patients. The assessed pressures and pelvic floor function measured with DRE by the surgeon and the pelvic floor physical therapist during rest, squeeze, and straining correlated in 78%, 78%, and 84%, respectively. Correlation between DRE and 3D-HRAM or s-EMG was better for squeeze pressures than resting pressures. The correlation between s-EMG and 3D-HRAM was better during squeeze than at rest with an agreement of 59% and 37%, respectively. Conclusion DRE by an experienced investigator is of sufficient value for daily clinical practice to detect dyssynergia and to measure sphincter tone. Commonly performed anorectal function tests correlate poorly with DRE and with other anorectal function tests. When conservative treatment fails, further investigation is warranted; however, these results should be interpreted with caution. What does this paper add to the literature? Anorectal function tests such as the 3D high-resolution anorectal manometry, balloon expulsion test, surface electromyography, and transperineal ultrasound are all frequently performed in the diagnostic workup in patients with defecation disorders. No previous study has compared these tests regarding their outcomes, nor has the interrater agreement been measured regarding the digital rectal examination by two experienced observers. Furthermore, transperineal ultrasound is in all probability not frequently used and therefore underexposed in the diagnostic workup of patients with dyssynergic defecation.

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“…Thus, the probability of missing both PCa and csPCa after new mpMRI revealed no high-grade PIRADS lesions appears to be minimal. In the RPCRC, the DRE-result plays a relatively important role in the decision-making [25]. Some men might have been erroneously labelled inconspicuous while having a pathologic DRE (e.g., cT2a), resulting in low-risk stratification.…”

Section: Discussionmentioning

confidence: 99%

Avoiding Prostate Biopsies in Patients at Low Risk for Prostate Cancer: A Prospective Evaluation of a PSA-Density-Based Safety Net

Bahlburg¹,

Tully²,

Hoffmann³

et al. 2023

Urol Int

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Introduction and Objectives: Decision-making to perform prostate biopsy should include individual risk assessment. Patients classified as low risk by the Rotterdam Prostate Cancer Risk Calculator are advised to forego biopsy (PBx). There is concern about missing clinically significant prostate cancer (csPCa). A clear pathway for follow-up is needed. Material and Methods: Data for 111 consecutive patients were collected. Patients were encouraged to adhere to a PSA-density-based safety net after PBx was omitted. Cut off values indicating a re-evaluation were PSA density >0.15 ng/mL/ccm in PBx-naïve patients and >0.2 ng/mL/ccm in men with past-PBx. Primary endpoint was whether men had their PSA taken regularly. Secondary endpoint was whether a new multiparametric MRI was performed when PSA-density increased. Tertiary endpoint was whether biopsy was performed when risk stratification revealed an increased risk. Results: Median follow-up was 12 months (IQR 9–15 months). The primary endpoint was reached by 97.2% (n = 106). The secondary endpoint was reached by 30% (n = 3). The tertiary endpoint was reached by 50% (n = 2). Histopathologic analyses revealed csPCa in none of these cases. Risk stratification did not change (p = 0.187) with the majority of patients (89.2%, n = 99). Conclusion: The concern of missing csPCa when omitting PBx in the risk-stratified pathway may be negated. Changes in risk stratification during follow-up should lead to subsequent PBx. We suggest implementing a safety net based on PSA density and digital rectal examination (DRE).

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Prospective evaluation on the effect of interobserver variability of digital rectal examination on the performance of the Rotterdam Prostate Cancer Risk Calculator

Abstract: Slight differences in digital rectal examination findings seem to have very limited impact on the performance of the Rotterdam Prostate Cancer Risk Calculator. Therefore, this can be considered a useful prostate biopsy outcome prediction tool.

Cited by 10 publications

References 25 publications

A systematic review of the accuracy of the digital rectal examination as a method of measuring prostate gland volume

A systematic review of the accuracy of the digital rectal examination as a method of measuring prostate gland volume

To what extent are anorectal function tests comparable? A study comparing digital rectal examination, anal electromyography, 3-dimensional high-resolution anal manometry, and transperineal ultrasound

Avoiding Prostate Biopsies in Patients at Low Risk for Prostate Cancer: A Prospective Evaluation of a PSA-Density-Based Safety Net

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