Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Digital Rectal Examination”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources
PubMed1999

Clinical significance of small (less than 0.2 cm3) hypoechoic lesions in men with normal digital rectal examinations and prostate-specific antigen levels less than 10 ng/mL.

OBJECTIVES: Most men diagnosed with prostate cancer in 1998 presented with a normal digital rectal examination (DRE) and minimal elevations in serum prostate-specific antigen (PSA) (less than 10 ng/mL). Considerable attention is often given toward identifying small hypoechoic (less than 0.2 cm3) lesions at the time of transrectal ultrasound-guided prostate biopsy. We sought to determine the significance of these lesions and whether an additional biopsy of this area is clinically useful. METHODS: A prospective data base containing detailed information on 614 biopsies performed by a single urologist was examined. All patients with a hypoechoic lesion underwent sextant prostate biopsy plus a separately labeled core directed through the hypoechoic area. Eighty-one patients who fit the following criteria were assessed: PSA less than 10 ng/mL, normal DRE, and hypoechoic lesion volume less than 0.2 cm3. RESULTS: The mean age of this group was 63.5 years, and the mean PSA was 7.1 ng/mL. Of the 81 patients with small hypoechoic lesions, 20 (24.7%) were positive for cancer in at least one prostatic core. Of the 81 hypoechoic area biopsies (HABs), 14 (17.3%) were positive for cancer; 1 (1.2%) demonstrated high-grade prostatic intraepithelial neoplasia, and 66 (81 .5%) were negative. In 11 of the patients (78.6%) with positive HABs, at least one additional core was positive for cancer. In 3 of the patients (21.4%) with positive HABs, no additional cores were positive for cancer (P<0.05). CONCLUSIONS: A significant proportion of small hypoechoic lesions in patients with early T1c prostate cancer are positive for malignancy. Although the overall yield of separate hypoechoic area biopsy is low (3.7%), approximately 15% of cancers would be missed if directed HABs were not performed (P<0.05). Identification and biopsy of small hypoechoic lesions are indicated in this group of patients.

Adult↗
PubMed1999

Effect of digital rectal examination on serum complexed and free prostate-specific antigen and percentage of free prostate-specific antigen.

OBJECTIVES: To evaluate the effects of digital rectal examination (DRE) on serum total, calculated complexed, and free prostate-specific antigen (PSA) and the free/total PSA ratio and factors affecting variations of PSA. METHODS: Serum total and free PSA and the percent free PSA ratio were determined in 91 urologically referred men (mean age 64 +/- 9 years) before and 30 minutes after DRE, with the Hybritech Tandem-R assay. Complexed PSA was calculated as the difference between total and free PSA. DRE effects on PSA were analyzed comparing pre-DRE and post-DRE values and by calculating the difference between pre-DRE and post-DRE PSA and the post/pre-DRE geometric ratio as a coefficient of variation. RESULTS: Thirty minutes after DRE, the increase in total, calculated complexed, and free PSA and the percent free PSA ratio was statistically significant. The difference between post-DRE and pre-DRE values of serum total, calculated complexed, and free PSA and percent free PSA was +0.9, +0.3, and +0.6 ng/mL and + 10%, respectively. The post/pre-DRE ratio of serum total, calculated complexed, and free PSA and percent free PSA was x1.5, x1.22, and x2.5 and x1.7, respectively. Patient age, DRE findings, prostate volume, prostate histologic features, and the initial value of total PSA had no statistically significant effect on the change of percent free PSA after DRE. The initial percent free PSA had a statistically significant effect on the change of percent free PSA after DRE. The values of calculated complexed PSA before and after DRE were significantly higher in patients with a prostate volume greater than 40 cc, prostate cancer on biopsy, and an initial free/total PSA ratio greater than 18%. CONCLUSIONS: In this study, DRE significantly increased total, calculated complexed, and free PSA and percent free PSA. The increase of PSA immediately after DRE was mainly due to the increase of free PSA. The change of percent free PSA after DRE depended on the initial percentage of free PSA. Complexed PSA seems less sensitive to DRE, and its changes after DRE were clinically modest. Free PSA measurement should be done before DRE and percent free PSA should be used only when the venipuncture is done before the DRE.

Aged↗
PubMed1998

Evaluation of the digital rectal examination as a screening test for prostate cancer. Rotterdam section of the European Randomized Study of Screening for Prostate Cancer.

BACKGROUND: The utility of digital rectal examination (DRE) as a screening test for early detection of prostate cancer has not been established. Therefore, we evaluated the usefulness of DRE as a stand-alone screening test and in conjunction with measured serum prostate-specific antigen (PSA) levels of 0-3.9 ng/mL and transrectal ultrasonography (TRUS). METHODS: Our study population consisted of 10,523 men aged 54-76 years who were randomly assigned to the screening arm of the Rotterdam, The Netherlands, section of the European Randomized Study of Screening for Prostate Cancer. The underlying prevalence of detectable prostate cancer was estimated by logistic regression analysis and used for calculating the sensitivity of DRE as a test. Pathologic characteristics of 105 radical prostatectomy specimens were used to determine the aggressiveness of the tumors diagnosed (and missed) by DRE. RESULTS: The overall detection rate for prostate cancer in this population when serum PSA measurement, DRE, and TRUS were used was 4.5%, and the detection rate with DRE alone was 2.5%. The positive predictive value of DRE ranged from 4% to 11% in men with PSA levels of 0-2.9 ng/mL and from 33% to 83% in men with PSA levels of 3.0-9.9 ng/mL or more. Most tumors detected by DRE in men with PSA levels of less than 4.0 ng/mL were small (mean volumes = 0.24-0.83 mL), and most were well differentiated (Gleason scores of 6 or less). Minimal, moderate, and advanced cancers were seen in 42%, 42%, and 16% of men, respectively, with a PSA level of 4.0 ng/mL or less. DRE alone allowed detection of 264 (55.8%) of 473 cancers; 82 (17.3%) of the 473 cancers would have remained undetected by PSA-based screening alone (i.e., no follow-up procedures for PSA values of 0-3.9 ng/mL). CONCLUSIONS: For PSA values of 0-3.9 ng/mL, the positive predictive value and sensitivity of DRE, tumor volume, and tumor grade were strongly dependent on PSA level. DRE has a poor performance in low PSA ranges.

Aged↗
PubMed2006

Prospective evaluation of the use and outcome of admission stool guaiac testing: the Digital Rectal Examination on Admission to the Medical Service (DREAMS) Study.

BACKGROUND: Although physicians often perform fecal occult blood testing at the time of hospital admission, the practice of admission stool guaiac (ASG) testing has not been evaluated prospectively. The aim of this study was to determine the frequency and outcomes of digital rectal examination (DRE) and ASG testing in patients admitted to the hospital. METHODS: We prospectively evaluated 2143 patients admitted to the medical service at our hospital over a 1-year period. A detailed clinical history was obtained, and the proportion of patients who had DRE and ASG testing, the frequency of positive tests, and the results of follow-up testing were determined. RESULTS: A DRE was performed in 1539 of the 2143 subjects (71.8%), and 1.8% had abnormal findings, 21.8% had a normal examination, and the result of ASG testing was the only documented finding in the remaining 76.4% of patients. ASG testing was performed in 1342 of the 2143 subjects (62.6%), and the ASG test was positive in 237 persons (17.7%). However, only 161 (67.9%) of those with a positive ASG test had further diagnostic testing and a colonic source of occult gastrointestinal blood loss was detected in 68 (42.2%) of these 161 persons. CONCLUSIONS: Although DRE and ASG testing are commonly performed on admission to the hospital, documentation of the findings and follow-up of positive tests are poor. These findings highlight the need to improve physician training on the appropriate use and documentation of the DRE and fecal occult blood testing.

Aged↗
PubMed1997

Analysis of the local control in lymph-node staged localized prostate cancer treated by external beam radiotherapy, assessed by digital rectal examination, serum prostate-specific antigen and biopsy.

OBJECTIVE: To describe local disease control after radical external beam radiotherapy of prostatic carcinoma, as judged by digital rectal examination (DRE), transrectal ultrasonography (TRUS)-guided biopsies and estimates of serum prostate-specific antigen (PSA). PATIENTS AND METHODS: The study comprised 175 patients (mean age 67.5 years, range 49-82; > 90% aged > or = 60 years) with localized prostatic carcinoma (T1-T3C, N0, M0) who underwent external beam radiation therapy (70 Gy), and were then regularly followed with a DRE, measurements of serum PSA and TRUS-guided biopsies to determine the outcome. RESULTS: The DRE revealed four patients with evidence of residual cancer in the prostate and biopsies showed no evidence of residual cancer in 131 (75%) of the patients. There was no correlation of residual cancer with tumour stage or grade but tumour size, as estimated by TRUS, correlated with the results of the biopsy. The nadir serum PSA level was < or = 1.0 ng/mL in 116 (66%) of the patients, of whom 76 (43%) had a nadir serum PSA level of < or = 0.5 ng/mL. The median time to the nadir level was 11 months. Serum PSA progression (> 4.0 ng/mL) at the latest PSA measurement after reaching the nadir occurred in 13% of the patients with a nadir PSA of < or = 0.5 ng/mL and in 25 of the 29 (86%) patients with a nadir serum PSA > 2.0 ng/mL. Cox regression analysis showed that tumour size and rectal irradiation dose were the most important factors for local control. CONCLUSIONS: Radiotherapy is effective in achieving local control in small prostate cancer tumours but less effective in large tumours. Tumour size and dorsal extension of the irradiated target, the rectal dose, were the two important factors for local control. A serum PSA level of < or = 1.0 ng/mL was associated with a higher chance of prolonged disease control.

Aged↗
PubMed1997

Evaluation of prostate specific antigen density and transrectal ultrasonography-guided biopsies in 100 consecutive patients with a negative digital rectal examination and intermediate serum prostate specific antigen levels.

BACKGROUND: This study was undertaken to assess the importance of prostate biopsies in patients with a negative digital rectal examination (DRE) and elevated prostate specific antigen (PSA) levels and to investigate the role of PSA density (PSAD) and hypoechoic lesions on transrectal ultrasound (TRUS) in increasing the diagnostic sensitivity and specificity for prostate cancer (PCa). METHODS: One hundred patients with varied initial symptoms who had a negative DRE and a PSA level between 4 and 20 ng/mL underwent TRUS-guided systematic and, if present, lesion-directed biopsies. RESULTS: PCa was detected in 11 patients (11%). TRUS examinations revealed hypoechoic lesions in 31 patients. Lesion-directed biopsies revealed PCa in 13% (4/31) of patients with abnormal TRUS whereas, 7% (5/69) of patients with negative TRUS findings had PCa. Additional systematic biopsies detected PCa in 2 patients where lesion-directed biopsies were negative. None (0/19) of the lesions smaller than 0.2 mL on TRUS had PCa whereas, 33% (4/12) of patients with lesions greater than 0.2 mL had PCa. When the subgroup of patients with negative TRUS and PSA levels between 4 and 10 ng/mL were considered, 25% (1/4) of cases with PCa would have been missed if 0.15 was used as the cut-off point for PSAD, however, this would save 61% (30/49) of unnecessary biopsies. The positive predictive value of PSA (cut-off level 10 ng/mL), PSAD (cut-off level 0.15), and hypoechoic lesions on TRUS were found to be 11.5%, 33%, and 13%, respectively. When hypoechoic lesions greater than 0.2 mL were taken as the positive finding, the positive predictive value and specificity rates of TRUS increased to 33% and 91%, respectively, without any change in the sensitivity. CONCLUSIONS: In patients with a negative DRE and intermediate PSA levels, the application of PSAD would have saved 49% of study patients with BPH from a biopsy, but would have missed 27% of PCa cases. By ignoring lesions smaller than 0.2 mL on TRUS, a very high specificity of 91% was achieved with a sensitivity of 36%. Thus, further investigations aimed at defining a better mode of diagnosis of PCa are warranted.

Biopsy↗
PubMed1997

Comparison of digital rectal examination, transrectal ultrasonography, and multicoil magnetic resonance imaging for preoperative evaluation of prostate cancer.

OBJECTIVE: A prospective study was designed to compare the potentials of digital rectal examination (DRE), transrectal ultrasound (TRUS), and magnetic resonance imaging (MRI) using integrated endorectal and pelvic phased-array coils for preoperative estimation of tumor volume and local extent of prostate cancer. METHODS: Evaluation of 20 consecutive patients undergoing radical retropubic prostatectomy included DRE, TRUS with a 7.5-MHz transducer, and MRI on a 1.5-tesla GE Signa system. Step sections (5 mm) of the entire specimen were performed, and tumor volume and percentage of gland involved were calculated. RESULTS: DRE, TRUS, and endorectal and pelvic phased-array MRI showed 50, 75, and 95% of the cancers, respectively. There was a linear correlation on MRI between predicted tumor volume and pathological tumor volume (r = 0.82, p < 0.0001), but not between predicted volume on DRE or TRUS and real volume. The accuracy for detecting extracapsular penetration was 60% for DRE and TRUS and 79% for MRI. The accuracy for detecting seminal vesicle invasion was 60% for DRE, 66 for TRUS, and 89% for MRI. The negative predictive value for extracapsular and seminal vesicle extension was highest for MRI (85 and 93%, respectively). The accuracy for tumor location in the apex of the prostate was 30% for DRE, 47 for TRUS, and 89% for MRI. CONCLUSIONS: MRI with integrated endorectal and pelvic phased-array coils satisfactorily predicted tumor volume and tumor extent preoperatively. Multicoil MRI can assist in decision making as it is valuable in the definition of patients that may benefit from surgery and can be of help for evaluating the risk of a positive margin, especially in the apical resection.

Aged↗
PubMed2006

An abnormal digital rectal examination is an independent predictor of Gleason > or =7 prostate cancer in men undergoing initial prostate biopsy: a prospective study of 790 men.

OBJECTIVE: To evaluate our experience with a referral population of 790 patients undergoing initial prostate biopsy in the prostate-specific antigen (PSA) era, to assess the role of a digital rectal examination (DRE) in predicting the outcome of prostate needle biopsy (PNB) and to evaluate if DRE findings were associated with cancer grade. PATIENTS AND METHODS: We analysed 790 consecutive men who had an initial PNB from September 1999 to July 2005 by one urologist (C.P.). All data were collected in a prospective database. Multivariate logistic regression analysis was used to determine the relationship between an abnormal DRE and the presence of cancer and cancer grade on PNB. RESULTS: An abnormal DRE was an independent predictor for prostate cancer on multivariate analysis (odds ratio 2.18, 95% confidence interval 1.53-3.10, P < 0.001). In all patients biopsied, an abnormal DRE was associated with a Gleason sum of > or = 7 on multivariate analysis (odds ratio 3.39, 2.07-5.53, P = 0.001). CONCLUSION: A DRE is a useful and important tool to use when assessing patients for a PNB. An abnormal DRE independently predicted high-grade disease in these men. These results might have important implications in the prediction of men with other than indolent prostate cancer.

Adult↗
PubMed1996

Effect of digital rectal examination on plasma prostate-specific antigen (PSA).

UNLABELLED: Presented are results of determination of plasma PSA before, 1 and 24 hours and 3 weeks after digital rectal examination (DRE) in 130 patients with prostatic adenoma (BPH). Mean pre-examination PSA level was 8.5 ng/ml (max. 27.0 ng/ml, min. 0.3 ng/ml, SD = 6.2). PSA rose at 1 and 24 hr. post-DRE: 9.4 ng/ml (max. 28.9 ng/ml, min. 0.5 ng/ml, SD = 6.7) and 10.7 ng/ml (max. 28.0 ng/ml, min. 0.5 ng/ml, SD = 7.9), respectively. CONCLUSION: in patients with prostatic adenoma DRE is followed by a rise in plasma PSA, which returns almost to baseline values by 3 weeks.

Aged↗
PubMed2001

Detection of prostatic carcinoma: the role of TRUS, TRUS guided biopsy, digital rectal examination, PSA and PSA density.

The purpose of this study was to evaluate the efficacy of various diagnostic tests including transrectal ultrasound (TRUS), TRUS guided biopsy, digital rectal examination (DRE), prostate specific antigen (PSA), and prostate specific antigen density (PSAD) in detecting prostatic carcinomas. One hundred and thirty-four men underwent TRUS guided random, or directed and random sonographic biopsies of the prostate. The mean age was 64.67 (range, 31- 88) years. Indications for biopsy were abnormal findings suggesting prostatic carcinoma on DRE or increased levels of PSA, defined as 4.0 ng/ml or greater in a monoclonal antibody assay. PSAD was calculated by dividing the serum PSA in ng/ml to the volume of the entire prostate in cm3. The biopsy results were grouped as benign, malign and, prostatitis. The patients were also divided into three groups according to their PSA values. Of the 134 patients evaluated, 31 (23.1%) had prostate adenocarcinoma, 89 (66.4%) had benign prostatic tissue, hyperplasia or prostatic intraepithelial neoplasia, and 14 (10.4%) had prostatitis. The mean PSA and PSAD of the carcinoma group were significantly higher than those of the noncancer group. In the group of patients with PSA levels between 4 and 10 ng/ml, abnormal TRUS or DRE increased cancer detection rate, where neither PSA nor PSAD was capable of discriminating the patients with and without cancer. PSAD did not prove to be superior to the other diagnostic tests in this study. We recommend biopsy when either TRUS or DRE is abnormal in patients with PSA levels between 4 and 10 ng/ml. In the patients with PSA levels greater than 10 ng/ml, biopsy is indicated whatever the findings on TRUS or DRE are, since cancer detection rate is high.

Adenocarcinoma↗
PubMed1994

Prostate-specific antigen and digital rectal examination in screening for prostate cancer: a community-based study.

In this study, 1,027 healthy men over age 40 were screened for prostate cancer with digital rectal examinations (DRE) and prostate-specific antigen (PSA) levels. Findings were abnormal in 189 (18%). PSA levels alone were abnormal (> 4.0 ng/mL) in 111 men (12%), 60 men (8%) had abnormal DRE and normal PSA, and 18 men had abnormal results of both examinations. Of the 189 men, 176 (93%) were referred for follow-up studies, and 39 cases of prostate cancer were detected. Of the 60 men with abnormal findings on DRE and normal PSA levels, only 2 men (3%) were found to have prostate cancer. Twenty-two of the 107 men (21%) with PSA levels between 4.0 and 9.9 ng/mL and 14 of 22 men (64%) with a PSA level greater than 10 ng/mL had prostate cancer. Conversely, 36 of the 39 men (92%) with prostate cancer had a PSA level greater than 4.0 ng/mL. Of 18 men with both abnormal DRE and elevated PSA, 9 (50%) were found to have prostate cancer. Overall, the 39 men found to have prostate cancer constituted 3.8% of the population screened; 25 of them (64%) had disease clinically confined to the prostate. PSA in combination with DRE appears to be useful in detecting prostate cancer in its early stages. Prospective randomized trials must be completed to determine whether early detection will have an impact on overall mortality from prostate cancer.

Adult↗
PubMed1993

[Role of prostate specific antigen, transrectal ultrasonography, and digital rectal examination in the search for clinical prostate cancer].

Two hundred and thirty-four patients who visited the urology clinic in Kitasato University Hospital were evaluated with digital rectal examination (DRE), serum prostate specific antigen (PSA) study and prostate ultrasonography. Of 71 men who underwent ultrasound-guided transrectal biopsy 19 (26.8%) were found to have prostate cancer, accounting for 8.1% (19/234) of the whole population. When PSA levels were arbitrarily divided into 0 to 2, 2.1 to 10 and greater than 10 ng/ml, the positive DRE was associated with cancer detection rate of 3.3%, 77.8% and 100%, respectively, with an overall detection rate of 32.6%. However, a normal DRE (benign-feeling gland) is associated with much less cancer detection rate of 5.9%, 28.6% and 100%, respectively, with an overall rate of only 16.0%. The positive biopsy rate was 30% (18/60) in the presence of hypoechoic lesions on sonography, but 9.1% (1/11) if absent. The positive predictive value of DRE (32.6%, 15/46) increased to 36.6% (15/41) if a hypoechoic lesion was identified sonographically and to 87.5% (14/16) if PSA levels were abnormal. One patient was found to have a microfocus of well differentiated adenocarcinoma in one of the 6 biopsy cores. Radical retropubic prostatectomy was performed in 9 of the 19 patients with clinically localized prostate cancer. On pathologic examination of the prostatectomy specimens 5 of them were upstaged to positive seminal vesicle or lymph node metastasis. The spectrum of prostate cancer detected by these modern techniques is broad and extends from tiny clinically insignificant cancer to advanced disease in its incurable stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

Biopsy-based diagnosis of prostate cancer in 1290 patients referred for prostate examination: results according to the PSA level, digital rectal examination and ultrasonography.

Authors present their retrospective study of 1290 patients referred for prostate evaluation. The risk of cancer was analysed according to PSA, rectal palpation and ultrasound examination. Among the 1290 patients, 54.8% had cancer. The risk of cancer was multiplied by 2.8 when the PSA was between the normal limit and 10 ng/ml, by 7.5 when it exceeded 10 ng/ml, by 4.0 when rectal palpation was abnormal and by 1.6 when a hypoechogenic zone was present. Although a hypoechogenic zone does not improve the detection of cancer compared to PSA and rectal palpation, an increased PSA level even lower than 10 ng/ml indicates biopsies.

Adult↗
PubMed1992

[Early diagnosis of prostatic cancer with digital rectal examination, PSA determination, and endorectal echography. Correlations with the morphologic diagnosis in 200 consecutive cases].

The proposal of an early diagnosis of prostate cancer through mass screening with digital rectal examination (DRE), transrectal ultrasound (TRUS) and serum tumor markers remains controversial: there is no high risk population. No study has proven that mass screening reduces the mortality from prostate cancer. However, when clinical and biological data give arguments for the presence of a cancer, every patient requires a prostate biopsy. We have studied the Positive Predictive Value (PPV) of each test in a selected population: 200 men over 50 years of age in which rectal examination or PSA assay was suspicious were investigated. Without any reference to the prostate volume, we considered that the PSA level was "suspicious" when it reached 3 times the upper reference value, or 12 ng/ml. DRE was suspicious in 73%, comprising 50% with prostate carcinoma. PSA assay was suspicious in 65%, comprising 61% with prostate carcinoma. 88% of cancers had a suspicious DRE or PSA assay. TRUS was suspicious in 89%, comprising 45% with prostate carcinoma. Ultrasound guided core biopsies were performed in each case, and allowed a positive diagnosis in 42% of cases, whereas bilateral fine-needle cyto-aspirates were positive in 87% of histologically proven carcinomas. Cytology alone was positive in 3 patients with negative biopsies. Both results show that the PPV of a suspicious DRE associated with an elevated PSA level is 84%. An increased PSA level is correlated with a cancer in 61%.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1995

Effect of digital rectal examination on serum prostate-specific antigen in a primary care setting. The Internal Medicine Clinic Research Consortium.

BACKGROUND: Measurement of serum prostate-specific antigen (PSA) and digital rectal examination (DRE) are commonly used for prostate cancer screening. Clinicians have been advised to avoid measuring serum PSA after DRE because of the possibility of spurious elevation. However, studies in healthy volunteers have found no change. We sought to determine whether DRE performed by internists affects PSA levels in a primary care clinic population. METHODS: Men older than 49 years enrolled in a Veterans Affairs internal medicine clinic were eligible for the study. For all patients, prostate size and nodularity were assessed by DRE. Blood for determination of PSA levels was drawn immediately before DRE and 30 minutes after DRE. All patients completed a questionnaire regarding voiding. RESULTS: Two hundred two men aged 50 to 85 years (mean, 67 years) were enrolled and had complete data. The mean PSA level increased by 0.26 micrograms/L after DRE (P < .001). Six patients (2.9%; 95% confidence interval, 0.6% to 5.3%) had an increase in PSA level from less than 4 micrograms/L to more than 4 micrograms/L after DRE. There was a statistically significant but weak correlation between voiding score and PSA level (coefficient, .17; P = .02). Patients with an enlarged prostate gland had higher PSA levels than did patients with normal prostates or borderline results of examination. Nodularity did not predict an increased PSA level. CONCLUSIONS: We conclude, in an elderly veteran population, that DRE causes a statistically significant but clinically insignificant increase in serum PSA level. Additionally, we found that symptoms and physical examination results cannot be used to select a population for whom PSA screening would likely be useful.

Aged↗
PubMed2001

Prostate-specific antigen (PSA) value change after antibacterial therapy of prostate inflammation, as a diagnostic method for prostate cancer screening in cases of PSA value within 4-10 ng/ml and nonsuspicious results of digital rectal examination.

OBJECTIVES: Investigation of the possibilities of improving the accuracy of prostate cancer (PC) screening among patients with a PSA value of 4-10 ng/ml and nonsuspicious results of digital rectal examination (DRE), using as diagnostic method the PSA value change (PSA-VCh) after antibacterial treatment of prostate inflammation. METHODS: The study included 61 patients with PSA 4-10 ng/ml, nonsuspicious DRE and inflammation in expressed prostate secretion (EPS). All these patients underwent antibacterial therapy with the following repeated PSA determination and PSA-VCh assessment. RESULTS: Antibacterial therapy led to PSA decrease in 80% of cases. Effectiveness of PSA-VCh in PC screening was estimated. Sensitivity of PSA-VCh (with cut-off point -0.1.100%) equaled 85%, specificity 96%, positive predictive value 85% and negative predictive value 96%. CONCLUSIONS: Prostate inflammation proves to be a significant factor contributing to serum PSA elevation up to 10 ng/ml among patients with nonsuspicious DRE. Assessment of PSA-VCh after antibacterial treatment can improve PC screening accuracy in cases of PSA 4-10 ng/ml, nonsuspicious DRE and inflammation in EPS.

Aged↗
PubMed1992

Prostate-specific antigen, digital rectal examination, and transrectal ultrasound in predicting the probability of cancer.

Over a 4 1/2 year period, 1,940 asymptomatic men were entered in a prostate cancer detection program consisting of digital rectal examination (DRE), prostate-specific antigen (PSA), and transrectal prostate ultrasound (TRUS). Four hundred and sixteen biopsies were performed resulting in the diagnosis of 79 cancers; 82% had clinically organ confined tumors. A recommendation for biopsy was made in 260 (62%) based on the TRUS alone, 55 (13%) by DRE alone, 92 (22%) when the DRE and TRUS were both abnormal, and in 9 (2.2%) cases when only PSA levels were elevated. The DRE, PSA, and TRUS were abnormal in 1,261 (65%), 989 (51%), and 1,552 (80%) of the patients with cancer, respectively. Prostate cancer detection increased as the serum PSA level increased above 4 ng/ml. The positive predictive value of both DRE and TRUS were significantly influenced by an elevated PSA, (P = .042 and P less than .00005, respectively). The results of this study support the idea that, although the prostate cancer detection rate is influenced by these three modalities and the detection rate of localized disease can be improved by early detection programs, its effect on mortality rates remains undefined at this time.

Aged↗
PubMed1994

Diagnosis of low back pain, secondary to prostate metastasis to the lumbar spine, by digital rectal examination and serum prostate-specific antigen.

OBJECTIVE: To present a case in which the initial diagnosis of spinal metastasis secondary to prostate cancer was established from findings of the digital rectal examination (DRE) and serum prostate-specific antigen (PSA) analysis. CLINICAL FEATURES: A 79-yr-old black male was seen after suffering from low back pain for 1 month. Urinary frequency and nocturia were associated symptoms. Abnormal findings on the DRE and serum PSA determination suggested a preliminary diagnosis of spinal metastases secondary to prostate cancer. Subsequent referral for biopsy and bone scan yielded the final diagnosis of prostate adenocarcinoma with spinal metastasis. Radiographs of the lumbosacral spinal region were inconclusive and results of routine laboratory tests (CBC, ESR, U/A) were within normal limits. INTERVENTION AND OUTCOME: The patient was referred for medical palliation of his condition. A bilateral orchiectomy was performed along with oral antiandrogen administration. At a consultation 8 months postoperatively, he reported to be free of pain. CONCLUSION: At least 40% of newly diagnosed cases of prostate cancer can be expected to have metastasized at the time of initial discovery. Routine use of DRE and serum PSA in patients complaining of low back pain who are at high risk for prostate cancer is recommended. However, mass screening with DRE or PSA in asymptomatic males is not recommended. There are no prospective studies showing evidence that mass screening for prostate cancer will reduce the mortality or morbidity rates from the disease.

Adenocarcinoma↗