Posted on January 14, 2013 by Sitemaster
A new study just published in the Canadian Journal of Urology has reminded us of the importance of the digital rectal emamination (DRE) in the initial diagnosis of prostate cancer.
The paper by Palmerola et al. used chart reviews to look at data from 806 men, all evaluated for risk of prostate cancer at their Pennsylvania-based, academic medical center in the recent past. In other words, this was a contemprary cohort of patients (but the study time frame is not given in the paper?s abstract). All patients had received an ultrasound-guided biopsy (with 12 to 18 biopsy cores being taken), a DRE, and assessment of their PSA level.
The research team divided the men into those with a relatively ?normal? PSA level or an ?abnormal? PSA level by using age-specific PSA guidelines. They alspo classified the patients into two groups based on the DRE results: smooth, age-appropriate, asymmetric, or uniformly enlarged prostates were defined a ?normal? and any type of nodule or induration on the prostate led to a classification as ?abnormal.?
Here are the core study findings:
- 516/806 patients (64 percent) had a normal DRE.
- 290/806 patients?(36 percent) had an abnormal DRE.
- 306/806 patients?(38 percent) were?found to have prostate cancer.
- Of these 306 patients,
- 136 (44 percent) had an abnormal DRE.
- 43 (14?percent) had an isolated DRE abnormality.
- Of the 136?patients with an abnormal DRE and prostate cancer, 43 (31 percent) had a normal age-specific PSA value.
- In this series of patients, for the detection of prostate cancer, an abnormal DRE was associated with
- A?sensitivity of 44 percent
- A specificity of 68 percent
- A?positive predictive value (PPV) of 46 percent
- A?negative predictive value (NPV) of 67 percent
- The type of DRE abnormality appeared to have no impact on the cancer detection rate.
Palmero et al. point out that, in this series, 43/806 men were diagnosed with prostate cancer (31 percent of the 306 men diagnosed)?had an isolated abnormality found during DRE despite the fact that their PSA was within the normal, age-specific range.
The accuracy and importance of the DRE when carried out by primary care physicians is certainly debatable (because primary care physicians may not be sufficiently skilled to conduct a prostate DRE bwith sufficient skill). What is not debatable is the importance of the DRE when the patient is being evaluated by a urologist either prior to biopsy or as part of a full urological examination.
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Filed under: Diagnosis, Risk Tagged: | biopsy, Diagnosis, digital, DRE, examination, rectal
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