DIGITAL RECTAL EXAMINATION FOR DETECTING PROSTATE CANCER AT PROSTATE SPECIFIC ANTIGEN LEVELS OF 4 NG./ML. OR LESS

No AccessJournal of UrologyClinical Urology: Original Article1 Mar 1999DIGITAL RECTAL EXAMINATION FOR DETECTING PROSTATE CANCER AT PROSTATE SPECIFIC ANTIGEN LEVELS OF 4 NG./ML. OR LESS GUSTAVO F. CARVALHAL, DEBORAH S. SMITH, DOUGLAS E. MAGER, CHRISTIAN RAMOS, and WILLIAM J. CATALONA GUSTAVO F. CARVALHALGUSTAVO F. CARVALHAL , DEBORAH S. SMITHDEBORAH S. SMITH , DOUGLAS E. MAGERDOUGLAS E. MAGER , CHRISTIAN RAMOSCHRISTIAN RAMOS , and WILLIAM J. CATALONAWILLIAM J. CATALONA View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)61785-3AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated the detection rate of prostate cancer in men with suspicious digital rectal examination findings and serum prostate specific antigen (PSA) 4 ng./ml. or less. We also evaluated the stage and grade of cancers detected. Materials and Methods: We screened 22,513 community volunteers by PSA testing and digital rectal examination at 6-month intervals. Biopsy was recommended when either test was suspicious for cancer. In the subset of 2,703 white and black men in whom PSA was 4 ng./ml. or less and digital rectal examination was suspicious for prostate cancer we compared compliance with biopsy recommendations, cancer detection rates, and stage and grade of cancers detected. We then correlated these results with patient age, race and serum PSA concentration. We performed multivariate logistic regression analysis to predict cancer based on clinical characteristics, and evaluated the positive predictive value of digital rectal examination for detecting cancer as stratified by race and PSA. Results: Of the men 70% underwent biopsy with no difference in compliance according to age, race or PSA level. The 13% cancer detection rate correlated with age, race and PSA (p <0.003). The positive predictive value of a suspicious digital rectal examination was 5, 14 and 30% in men with PSA 0 to 1.0, 1.1 to 2.5 and 2.6 to 4.0 ng./ml., respectively. All cancers were clinically localized. Of the 72% of cases that were surgically staged 82% were organ confined and 78% were moderately differentiated. Conclusions: The positive predictive value of suspicious digital rectal examination was appreciable in men with low serum PSA. The majority of cancer cases detected by digital rectal examination had features of clinically important and potentially curable disease. References 1 : Cancer statistics, 1998. CA1998; 48: 6. Google Scholar 2 : Economics of screening for carcinoma of the prostate. Urol. Clin. N. Amer.1990; 17: 719. Google Scholar 3 : Incidence of prostate cancer diagnosis in the eras before and after prostate-specific antigen testing. J.A.M.A.1995; 274: 1445. Google Scholar 4 : The early detection of prostate carcinoma with prostate specific antigen: the Washington University experience. Cancer1997; 80: 1852. Google Scholar 5 : A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. J.A.M.A.1995; 273: 289. Google Scholar 6 : Longitudinal screening for prostate cancer with prostate-specific antigen. J.A.M.A.1996; 276: 1309. Google Scholar 7 : Prospective longitudinal evaluation of men with initial prostate specific antigen levels of 4.0 ng/ml or less. J. Urol.1996; 157: 1740. Google Scholar 8 : Recommended prostate-specific antigen testing intervals for the detection of curable prostate cancer. J.A.M.A.1997; 277: 1456. Google Scholar 9 : Disease-specific survival following routine prostate cancer screening by digital rectal examination. J.A.M.A.1993; 269: 61. Google Scholar 10 : Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicentric clinical trial of 6,630 men. J. Urol.1994; 151: 1283. Abstract, Google Scholar 11 : Early detection of prostate cancer: prior probability and effectiveness of tests. Ann. Internal Med.1997; 126: 394. Google Scholar 12 : Assessment of screening for prostate cancer using the digital rectal examination. J. Urol.1989; 141: 1136. Link, Google Scholar 13 : Interexaminer variability of digital rectal examination in detecting prostate cancer. Urology1995; 45: 70. Google Scholar 14 : African-American men: perceptual determinants of early cancer detection and cancer risk reduction. Cancer Nurs.1991; 14: 281. Google Scholar 15 : European randomized study of screening for prostate cancer (ERSPC): the accuracy of DRE and PSA transition zone density in diagnosing prostate cancer. J. Urol.1998; 159: 233. abstract 891. Google Scholar 16 : Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening. J.A.M.A.1993; 270: 948. Google Scholar 17 : Screening for prostate cancer: a decision analytic view. J.A.M.A.1994; 272: 773. Google Scholar 18 : Future benefits and cost-effectiveness of prostate carcinoma screening. Cancer1997; 80: 1864. Google Scholar 19 : Racial differences in operating characteristics of prostate cancer screening tests. J. Urol.1997; 158: 1861. Link, Google Scholar 20 : Cancer statistics by race and ethnicity. CA1998; 48: 31. Google Scholar From the Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MissouriSupported by grants from Hybritech, Inc., San Diego, California, and the Foundation for the Coordination of Higher Education and Graduate Training of the Brazilian Government (CAPES), Brasilia, Brazil.(CATALONA) Requests for reprints: Division of Urologic Surgery, Washington University School of Medicine, 4690 Children's Pl., St. Louis, Missouri 63110.© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byGaylis F, Nasseri R, Swift S, Levy S, Prime R, Dijeh U, Prock D, Dato P, Cohen E and Kane C (2020) Leveraging the Electronic Medical Record Improves Prostate Cancer Clinical Staging in a Community Urology PracticeUrology Practice, VOL. 8, NO. 1, (47-52), Online publication date: 1-Jan-2021.Andonian S, Triaca V, Yates J and Babayan R (2019) How Often is Digital Rectal Examination Performed? Is it Still Taught to Medical Students?Urology Practice, VOL. 7, NO. 2, (115-121), Online publication date: 1-Mar-2020.Lucarelli G, Rutigliano M, Bettocchi C, Palazzo S, Vavallo A, Galleggiante V, Trabucco S, Di Clemente D, Selvaggi F, Battaglia M and Ditonno P (2013) Spondin-2, a Secreted Extracellular Matrix Protein, is a Novel Diagnostic Biomarker for Prostate CancerJournal of Urology, VOL. 190, NO. 6, (2271-2277), Online publication date: 1-Dec-2013. (2018) AUA Guideline on Management of Benign Prostatic Hyperplasia (2003). 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Volume 161Issue 3March 1999Page: 835-839 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information GUSTAVO F. CARVALHAL More articles by this author DEBORAH S. SMITH More articles by this author DOUGLAS E. MAGER More articles by this author CHRISTIAN RAMOS More articles by this author WILLIAM J. CATALONA More articles by this author Expand All Advertisement PDF downloadLoading ...