© 1998 by Oxford University Press
Journal Of The National Cancer Institute, Vol 90, 1817-1823, Copyright © 1998 by Oxford University Press
FH Schroder, P van der Maas, P Beemsterboer, AB Kruger, R Hoedemaeker, J Rietbergen and R Kranse
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.
ARTICLES
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
Department of Urology, Erasmus University, Rotterdam, The Netherlands. vanalphen@urol.azr.nl
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