Does digital rectal examination predict prostate volume greater than 30 mL?

Abstract

Abbreviations & Acronyms BPH = benign prostatic hyperplasia DRE = digital rectal examination F = flat LUTS = lower urinary tract symptoms LUTS/BPH = lower urinary tract symptoms suggestive of benign prostatic hyperplasia Ma = markedly enlarged Mo = moderately enlarged N = normal PV = prostate volume S = slightly enlarged TRUS = transrectal ultrasound Objectives: To investigate the accuracy of digital rectal examination in estimating prostate volume in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Methods: A community-based study was carried out in Japan to investigate the prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia. A total of 457 men were screened and deemed eligible for the present analysis. Findings on digital rectal examination were compared with prostate volume measurement by transrectal ultrasound. Five groups were identified on digital rectal examination: flat, normal, slightly enlarged, moderately enlarged and markedly enlarged. Results: The median age and prostate volume were 64 years and 19.7 mL, respectively. Prostate volumes for the flat, normal, slightly enlarged, moderately enlarged, and markedly enlarged groups were 16.4, 18.3, 27.0, 41.9 and 86.3 mL, respectively. There were significant differences in prostate volume between the groups. The positive predictive value was 94.1% if flat, and normal were assumed to have a prostate volume <30 mL. The value was 80.8% if moderately enlarged, and markedly enlarged were assumed to have a prostate volume ≥30 mL. Of the men in the slightly enlarged group, 61.0% had a prostate volume <30 mL. Conclusions: It is possible to stratify prostate volume according to digital rectal examination. We could determine the prostates in the flat and normal groups to have a prostate volume <30 mL, and those in the moderately enlarged and markedly enlarged groups to have a prostate volume ≥30 mL by digital rectal examination with high accuracy. Transrectal ultrasound was required for those in the slightly enlarged group.

A systematic review of the accuracy of the digital rectal examination as a method of measuring prostate gland volume

“…The summary data for these studies are presented in Table 2, in chronological order. 5,12,13,[24][25][26][27][28][29] Several studies have indicated that that there was a tendency for DRE to over or underestimate the reference PGV, such that the estimation of the PGV by DRE was most accurate when the PGV was close to the median value of the reference PGV for the patients in those studies. DRE tended to overestimate the PGV when the PGV was smaller than the median reference value and tended to underestimate the PGV when it was larger.…”

“…These studies include some recent publications, confirming that it remains a topic of interest. [4][5][6] Our aim was to perform the first ever systematic review of the literature on this topic.…”

Is Digital Rectal Examination Still Valuable for Measuring the Prostate Volume in Clinical Practice?

“…13 However, as these methods are time-consuming and costly for assessing the prostate volume, they are seldom available for initial patient evaluations. 7,14 The use of TRUS can be limited, especially in patients without an anus, in the treatment of rectal cancer. In such cases, prostate volumes estimated using two different measurement methods of less than 2.5 cc.…”