Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men

Abstract

To compare the efficacy of digital rectal examination and serum prostate specific antigen (PSA) in the early detection of prostate cancer, we conducted a prospective clinical trial at 6 university centers of 6,630 male volunteers 50 years old or older who underwent PSA determination (Hybritech Tandom-E or Tandem-R assays) and digital rectal examination. Quadrant biopsies were performed if the PSA level was greater than 4 μg./l. or digital rectal examination was suspicious, even if transrectal ultrasonography revealed no areas suspicious for cancer. The results showed that 15% of the men had a PSA level of greater than 4 μg./l., 15% had a suspicious digital rectal examination and 26% had suspicious findings on either or both tests. Of 1,167 biopsies performed cancer was detected in 264. PSA detected significantly more tumors (82%, 216 of 264 cancers) than digital rectal examination (55%, 146 of 264, p = 0.001). The cancer detection rate was 3.2% for digital rectal examination, 4.6% for PSA and 5.8% for the 2 methods combined. Positive predictive value was 32% for PSA and 21% for digital rectal examination. Of 160 patients who underwent radical prostatectomy and pathological staging 114 (71%) had organ confined cancer: PSA detected 85 (75%) and digital rectal examination detected 64 (56%, p = 0.003). Use of the 2 methods in combination increased detection of organ confined disease by 78% (50 of 64 cases) over digital rectal examination alone. If the performance of a biopsy would have required suspicious transrectal ultrasonography findings, nearly 40% of the tumors would have been missed. We conclude that the use of PSA in conjunction with digital rectal examination enhances early prostate cancer detection. Prostatic biopsy should be considered if either the PSA level is greater than 4 μg./l. or digital rectal examination is suspicious for cancer, even in the absence of abnormal transrectal ultrasonography findings.

Effect of the Multiple Intravenous Administration of Cultured Human Autologous Adipose-Derived Stem Cells on Tumor Biomarker Levels

“…Therefore, it has been used for the early diagnosis of prostate cancer. Since Wang et al [28] introduced a PSA purification method from prostate tissue in 1979, it has become the most useful test for early diagnosis due to its positive predictive value [29], high reproducibility, affordability and simplicity. However, its results are not satisfactory to sensitivity and specificity, leading to continuous attempts to increase these values [30].…”

Microvascular density in prostate core biopsy: Prognostic predictors?

“…7,8,9 Definitivna dijagnoza se postavlja histopatološkim pregledom core biopsija prostate, na osnovu kojih se određuju prognostički parametri kao što su stepen diferentovanosti tumora, prisutvo i /ili odsustvo perineuralne i invazije vaskularnih struktura. Stepen proširenosti karcinoma prostate je među najvažnijim faktorima koji određuje prognozu bolesti i u velikoj meri zavisi od stepena angiogeneze.…”

Diagnostic value of microRNAs in prostate cancer patients with prostate specific antigen (PSA) levels between 2, and 10 ng/mL

“…[2,3] Diagnosis of PCa when it is organ-confined is important in order to increase disease-free survival, and decrease mortality rates. To this end annual prostate-specific antigen (PSA) screening tests combined with digital rectal examination (DRE) have been recommended after [5][6][7] In the presence of suspect mass, transrectal ultrasound-guided (TRUS) prostate biopsy has been used as a gold standard diagnostic method for PCa. [5][6][7] As the most frequently used tumor marker nowadays, PSA contributes considerably to early diagnosis, staging, and follow-up of PCa.…”

“…To this end annual prostate-specific antigen (PSA) screening tests combined with digital rectal examination (DRE) have been recommended after [5][6][7] In the presence of suspect mass, transrectal ultrasound-guided (TRUS) prostate biopsy has been used as a gold standard diagnostic method for PCa. [5][6][7] As the most frequently used tumor marker nowadays, PSA contributes considerably to early diagnosis, staging, and follow-up of PCa. Introduction of PSA, and its derivatives which aim to enhance sensitivity of PSA, into clinical practice has facilitated establishment of diagnosis of PCa at an early stage, and incidence of localized PCa has skyrocketed.…”