Login to Access Video or Poster Abstract: MP33-13
Sources of Funding: none

Introduction

In the United States a majority of prostate cancers are detected by an abnormal prostate specific antigen (PSA) level. In 2012 the U.S. Preventive Services Task Force recommended against the routine use of PSA based screening for prostate cancer, but did not fully address screening via digital rectal exam (DRE). The American Urologic Association recommends "informed decision with a doctor" starting at age 40 with baseline PSA and digital rectal exam._x000D_ DRE is known to detect some prostate cancers that are missed by PSA screening. The use of DRE is controversial as there is a high inter-observer variability and is subjective in nature. An abnormal DRE is a risk factor for high grade disease. With the USPTF recommendations many primary care physicians are not including digital rectal exam as part of their routine physical diagnosis. We sought to evaluate the clinical relevance of DRE in todays practice. _x000D_

Methods

Based on systematic title literature search of articles including "digital rectal exam" and "prostate cancer" in pubmed, 204 studies could be identified in which the diagnostic value of DRE was studied. Only studies in which an unselected population which used biopsy as the reference standard of presence of disease were included. Biopsy prompts included abnormal DRE, elevated PSA and abnormal transrectal ultrasound. Only studies in which it was possible to calculate the true positive, true negative, false positive and false negative rates were included. Twenty-two articles met the above criteria. Statistical pooling was based on a random effects model.

Results

Total sample size was 20,434 patients undergoing biopsy. Pooling of the studies revealed a high negative predictive value (.76). A modest sensitivity (.58) and specificity (.58) was observed. The positive predictive value (.38) was low. Heterogeneity between the studies was high.

Conclusions

The DRE appears to be a test with a high negative predictive value. When DRE is normal the chance of missing cancer is approximately 24%. When a patient has an abnormal DRE the chance of diagnosing prostate cancer is about 38%. This is higher than the predictive value of an elevated PSA between 4-10ng/dl. With that in mind and the fact that DRE exerts little or no cost to the system, this study suggests that DRE still has utility in patient care when evaluating for their risk for prostate cancer.

Funding

none