The diagnostic test accuracy of rectal examination for prostate cancer diagnosis in symptomatic patients: a systematic review

Jones, Daniel; Friend, Charlotte; Dreher, Andreas W.; Allgar, Victoria; Macleod, Una

doi:10.1186/s12875-018-0765-y

Cited by 48 publications

(37 citation statements)

References 15 publications

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“…In line with this idea, the results obtained herein demonstrate that high urine GOAT levels were associated to a higher risk of developing PCa as well as clinically significant PCa, independently of other parameters clinically relevant for PCa diagnosis and PCa patient's management, including Gleason score, PSA, age and DRE [14,23,24]. Indeed, the diagnostic capacity of urine GOAT levels to identify patients with PCa is comparable to that of the current gold standard plasma PSA levels.…”

Section: Discussionsupporting

confidence: 81%

Clinical Utility of Ghrelin-O-Acyltransferase (GOAT) Enzyme as a Diagnostic Tool and Potential Therapeutic Target in Prostate Cancer

Jiménez‐Vacas

Gómez‐Gómez

Montero-Hidalgo

et al. 2019

JCM

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Recent data suggested that plasma Ghrelin O-Acyl Transferase enzyme (GOAT) levels could represent a new diagnostic biomarker for prostate cancer (PCa). In this study, we aimed to explore the diagnostic and prognostic/aggressiveness capacity of GOAT in urine, as well as to interrogate its putative pathophysiological role in PCa. We analysed urine/plasma levels of GOAT in a cohort of 993 patients. In vitro (i.e., cell-proliferation) and in vivo (tumor-growth in a xenograft-model) approaches were performed in response to the modulation of GOAT expression/activity in PCa cells. Our results demonstrate that plasma and urine GOAT levels were significantly elevated in PCa patients compared to controls. Remarkably, GOAT significantly outperformed PSA in the diagnosis of PCa and significant PCa in patients with PSA levels ranging from 3 to 10 ng/mL (the so-called PSA grey-zone). Additionally, urine GOAT levels were associated to clinical (e.g., Gleason-score, PSA levels) and molecular (e.g., CDK2/CDK6/CDKN2A expression) aggressiveness parameters. Indeed, GOAT overexpression increased, while its silencing/blockade decreased cell-proliferation in PCa cells. Moreover, xenograft tumors derived from GOAT-overexpressing PCa (DU145) cells were significantly higher than those derived from the mock-overexpressing cells. Altogether, our results demonstrate that GOAT could be used as a diagnostic and aggressiveness marker in urine and a therapeutic target in PCa.

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Section: Discussionsupporting

confidence: 81%

Clinical Utility of Ghrelin-O-Acyltransferase (GOAT) Enzyme as a Diagnostic Tool and Potential Therapeutic Target in Prostate Cancer

Jiménez‐Vacas

Gómez‐Gómez

Montero-Hidalgo

et al. 2019

JCM

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“…DRE in the diagnosis of prostate cancer in primary care is also somewhat controversial, but has some stronger evidence for its use. Hamilton et al [ 26 ] found a PPV of 12% (95% CI 5.37) for an abnormal DRE deemed to be malignant by a GP, and a recently published systematic review of all studies of DRE for prostate cancer diagnosis in symptomatic patients in primary care found a pooled PPV of 42.3% [ 5 ]. This data suggests that, despite the reservations of some doctors in performing DREs, primary care clinicians can differentiate between a benign and malignant prostate on examination to a considerable extent.…”

Section: Symptoms and Signsmentioning

confidence: 99%

“…Digital rectal examination (DRE) is recommended in many countries alongside PSA to aid decision-making about referral for diagnostic testing. A recent systematic review suggests that DRE has a high specificity and positive predictive value (PPV) for prostate cancer in symptomatic patients [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Prostate Cancer in Primary Care

2018

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Prostate cancer is a common malignancy seen worldwide. The incidence has risen in recent decades, mainly fuelled by more widespread use of prostate-specific antigen (PSA) testing, although prostate cancer mortality rates have remained relatively static over that time period. A man’s risk of prostate cancer is affected by his age and family history of the disease. Men with prostate cancer generally present symptomatically in primary care settings, although some diagnoses are made in asymptomatic men undergoing opportunistic PSA screening. Symptoms traditionally thought to correlate with prostate cancer include lower urinary tract symptoms (LUTS), such as nocturia and poor urinary stream, erectile dysfunction and visible haematuria. However, there is significant crossover in symptoms between prostate cancer and benign conditions affecting the prostate such as benign prostatic hypertrophy (BPH) and prostatitis, making it very challenging to distinguish between them on the basis of symptoms. The evidence for the performance of PSA in asymptomatic and symptomatic men for the diagnosis of prostate cancer is equivocal. PSA is subject to false positive and false negative results, affecting its clinical utility as a standalone test. Clinicians need to counsel men about the risks and benefits of PSA testing to inform their decision-making. Digital rectal examination (DRE) by primary care clinicians has some evidence to show discrimination between benign and malignant conditions affecting the prostate. Patients referred to secondary care for diagnostic testing for prostate cancer will typically undergo a transrectal or transperineal biopsy, where a number of samples are taken and sent for histological examination. These biopsies are invasive procedures with side effects and a risk of infection and sepsis, and alternative tests such as multiparametric magnetic resonance imaging (mpMRI) are currently being trialled for their accuracy and safety in diagnosing clinically significant prostate cancer.

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“…The challenge to orient biopsy decision making is especially present when evaluating patients within the “prostate‐specific antigen (PSA) grey zone” of total PSA (tPSA) 4‐10 ng/mL or 2‐10 ng/mL, a growing cohort of patients with an ageing population, where test performance can vary. The decision to biopsy is further compounded when considering the influence of prostate volume, family history, prior biopsy status and digital rectal exam (DRE) status …”

Section: Introductionmentioning

confidence: 99%

“…The decision to biopsy is further compounded when considering the influence of prostate volume, 4 family history, 5 prior biopsy status 6 and digital rectal exam (DRE) status. 7 The diagnostic tools currently available are generally PSA based, using other forms of PSA, different molecular markers or mathematical combinations of such markers. 8 While they represent an improvement, their performance levels vary depending on the validation cohort used and the intended target population in terms of PSA range, prostate volume and DRE characteristics.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a novel multivariate risk score to guide biopsy decision for the diagnosis of clinically significant prostate cancer

Klocker

Golding²,

Weber³

et al. 2020

BJUI Compass

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Objectives Selecting patients suspected of having prostate cancer (PCa) for a prostate biopsy remains a challenge. Prostate‐specific antigen (PSA)‐based testing is hampered by its low specificity that often leads to negative biopsy results or detection of clinically insignificant cancers, especially in the 2‐10 ng/mL range. The objective was to evaluate a novel diagnostic test called Proclarix incorporating thrombospondin‐1 and cathepsin D alongside total and free PSA as well as age for predicting clinically significant PCa. Patients and methods The test was developed following a retrospective study design using biobanked samples of 955 men from two reference centres. A multivariate approach was used for model development followed by validation to discriminate significant (grade group ≥2) from insignificant or no cancer at biopsy. The test specificity, positive predictive value (PPV) and negative predictive value (NPV) at a fixed sensitivity of 90% were compared to percent free PSA (%fPSA) alone. The number of avoidable prostate biopsies deemed to be representative of clinical utility was also assessed. Results In the targeted patient population, the test displayed increased diagnostic accuracy compared to %fPSA alone. Application of the established model on 955 patients at a fixed sensitivity of 90% for significant disease resulted in a specificity of 43%, NPV of 95% and a PPV of 25%. This is in comparison to a specificity of 17%, NPV of 89% and PPV of 19% for %fPSA alone and had the potential to reduce the total number of biopsies needed to identify clinically significant cancer. Further, the test score correlated with significance of cancer assessed on prostate biopsy. Conclusions The Proclarix test can be used as an aid in the decision‐making process if to biopsy men in this challenging patient population. The use of the test could reduce the number of biopsies performed avoiding invasive procedures, anxiety, discomfort, pain and complications.

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The diagnostic test accuracy of rectal examination for prostate cancer diagnosis in symptomatic patients: a systematic review

Cited by 48 publications

References 15 publications

Clinical Utility of Ghrelin-O-Acyltransferase (GOAT) Enzyme as a Diagnostic Tool and Potential Therapeutic Target in Prostate Cancer

Clinical Utility of Ghrelin-O-Acyltransferase (GOAT) Enzyme as a Diagnostic Tool and Potential Therapeutic Target in Prostate Cancer

Prostate Cancer in Primary Care

Development and validation of a novel multivariate risk score to guide biopsy decision for the diagnosis of clinically significant prostate cancer

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