Utility of digital rectal examination in a population with prostate cancer treated with active surveillance

• Published in: Canadian Urological Association journal 2020-09, Vol.14 (9), p.E453-E457
• Main Authors: Herrera-Caceres, Jaime O, Wettstein, Marian S, Goldberg, Hanan, Toi, Ants, Chandrasekar, Thenappan, Woon, Dixon T S, Ahmad, Ardalan E, Sanmamed-Salgado, Noelia, Alhunaidi, Omar, Ajib, Khaled, Nason, Gregory, Tan, Guan Hee, Fleshner, Neil, Klotz, Laurence
• Format: Article
• Language: English
• Subjects: Medical societies; Original Research; Prostate cancer; Rectal examination
• ISSN: 1911-6470; 1920-1214
• DOI: 10.5489/cuaj.6341

Digital rectal examination (DRE) is part of the clinical evaluation of men on active surveillance (AS). The purpose of the present study is to analyze the value of DRE as a predictor of upgrading in a population of men with prostate cancer (PC) treated with AS. We used the prostate biopsy (PBx) database from an academic center, including PBx from 2006-2018, and identified 2029 confirmatory biopsies (CxPBx) of men treated with AS, of which 726 men had both diagnostic (initial) and CxPBx information available. We did a descriptive analysis and evaluated sensitivity, specificity, and predictive values of DRE for the detection of clinically significant PC (csPC). Multivariable regression analysis was done to identify predictors of csPC. The primary outcome was to evaluate DRE as a predictor of the presence of csPC at CxPBx. Among the 2029 patients with a CxPBx, 75% had PC, and of these, 30.3% had upgrading to ISUP Grade ≥2. Thirteen percent of men had a suspicious DRE (done by their treating physician). Sensitivity, specificity, negative and positive predictive values of DRE to detect csPC were best with a PSA