Predictive value of DRE reaffirmed in large cohort

Findings from a large study of prospectively evaluated men demonstrate that digital rectal exam is an independent predictor of prostate cancer in men undergoing prostate needle biopsy.

The trial included data from 914 consecutive men who underwent prostate needle biopsy between January 2000 and July 2004 at Virginia Mason Medical Center, Seattle. All evaluations and biopsies were performed by a single surgeon -- Christopher R. Porter, MD, attending, section of urology and renal transplantation.

The patients ranged in age from 23 to 91 years old (mean, 63.9 years) and had a mean PSA of 11.2 ng/mL. Based on prebiopsy evaluations, 476 men (52%) were considered to have an abnormal DRE. A total of 334 men (36.5%) were found to have cancer on biopsy.

Univariate and multivariate analyses considered a variety of prebiopsy parameters to determine those predictive of prostate cancer on biopsy. DRE had independent predictive value in the multivariate analysis (p=.002) considering the overall cohort and continued be an independent predictor in subset analyses including only men with low and moderate voiding symptoms based on AUA symptom score and in those with PSA levels ranging between 2.5 ng/mL and 10.0 ng/mL.

"There is controversy in the urologic community regarding the value of DRE in men referred for prostate biopsy, as various studies have generated conflicting findings," said Kalyan C. Latchamsetty, MD, a fellow in laparoscopic and urologic oncology at Virginia Mason. "The results from this very large, prospectively evaluated cohort indicate clinicians should continue performing routine physical examinations for prostate cancer screening because DRE is an important predictor."