Screening for Prostate Cancer: Digital rectal examination: outdated or still valuable?

摘要: textabstractIntroduction and Objective: Digital rectal examination (DRE) is an important diagnostic tool of a urologist it has been incorporated in screening programmes for prostate cancer (PC), such as the European Randomized Study Screening Prostate Cancer (ERSPC). In Rotterdam section this study, until 1997, man with PSA level ≥4.0 ng/ml or abnormal result on DRE TRUS (transrectal ultrasound) was offered lateralised sextant biopsy. After 1997 however, were discontinued biopsy indication simultaneously threshold lowered to 3.0 ng/ml. While clearly not shown be valuable test early detection PC, value more controversial. study we summarise evidence position PSA-based screening. Methods First, assessed variability percentage positive between different physicians. Furthermore, evaluated additional effect chance men elevated PSA, differences characteristics tumours detected range 2.0-4.0 due cut-off, long-term having DRE. Finally, omitting from protocol analysed. Results A subject interobserver variability, varying 4% 28%. At very low (<4.0 ng/ml), poor PPV approximately 10%. A suspicious compared normal findings, addition increased finding at initial 22.4% 48.6%. This independent observer, but diminished subsequent rounds. ng/ml, selectively detects high-grade cancers when biopsying all men, still missed many these. On long-term, initially negative gives no worse outcomes regarding later. Omitting TRUS, while lowering resulted overall decrease 10% rate biopsies, remained similar 4.7%. relatively short-term follow-up, neither i! ncreased risk interval PC rounds. Conclusions At first used increases both detecting clinically significant disease. could therefore use optimise subgroups men. However, predictive setting, suitable solitary values.