Evaluation of the Digital Rectal Examination as a Screening Test for Prostate Cancer

Schroder, F.H.; Maas, P. van der; Beemsterboer, P; Kruger, A.B.; Hoedemaeker, R; Rietbergen, J; Kranse, R

doi:10.1093/oxfordjournals.jnci.a024151

Cited by 11 publications

(17 citation statements)

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“…As clearly suggested in our previous report [14] and well demonstrated by the present update and extension of the previous data, the most cost-effective strategy is measurement of serum PSA as a first-line approach as recently concluded by Schrö der and colleagues [13] in another large-scale screening study. In fact, PSA is free of subjective assessment, is a procedure easily acceptable by the general population, and requires minimal health professional personnel.…”

Section: Resultssupporting

confidence: 83%

“…Abnormal DRE at first visit, on the other hand, had no influence on prostate cancer diagnosis at follow-up visits in men with normal PSA. In the Rotterdam section of the ERSPC screening study, 17.3% of cancers would have been missed by PSA alone using a cut-off value of 4.0 ng/ml [13]. Since 35 cancers were detected at a PSA value of 3.0 to 3.9 ng/ml, only 47 cancers (9.9%) would have been missed if DRE had not been used at first visit using 3.0 instead of 4.0 ng/ml PSA as upper limit of normal.…”

Section: Discussionmentioning

confidence: 99%

“…It is clear that such information can only be obtained from largescale studies. The interest in this area is particularly high following the decision of the European Randomized Study Screening for Prostate Cancer (ERSPC) not to use DRE for screening when PSA is normal (Յ 3.0 ng/mL) [13]. It will also be of interest to compare the results obtained in the groups of men invited and not invited for screening.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of prostatic specific antigen and digital rectal examination as screening tests for prostate cancer

et al. 2000

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BACKGROUND The 11,811 first visits and 46,751 annual follow‐up visits performed since 1988 were analyzed in order to assess the efficacy of serum prostatic specific antigen (PSA) and digital rectal examination (DRE) for diagnosis of prostate cancer. METHODS At first visit, screening included DRE and measurement of PSA using 3.0 ng/ml as upper limit of normal, demonstrated as optimal value in the course of the study. Transrectal echography of the prostate (TRUS) was performed only if PSA and/or DRE was abnormal. For elevated PSA, biopsy was performed only if PSA was above the value predicted from prostatic volume measured by TRUS. At follow‐up visits, it was decided during the course of the study to use PSA alone. RESULTS PSA was above 3.0 ng/ml in 16.6% and 15.6% of men at first and follow‐up visits, respectively. Prostate cancer was found in 2.9% of men invited for screening at first visit and in only 0.4% of men at follow‐up visits for a 7.1‐fold decrease at follow‐up visits done up to 11 years. PSA alone allowed to find 90.5% and 90.0% of cancers at first and follow‐up visits, respectively, compared to 41.1% and 25.0% by DRE alone. In the presence of normal PSA, 344 and 1,919 DREs are needed to find one prostate cancer at first and follow‐up visits, respectively. A significant improvement in stage of the disease is found at follow‐up (215 cancers) compared to first visits (337 cancers). Comparison made between men invited for screening and those who were not invited but screened showed no significant difference in terms of incidence and prevalence of prostate cancer as well as diagnosis of cancer as a function of age or as a function of PSA, DRE, and TRUS data. The cost for finding one case of prostate cancer is estimated at Can $2,420 and Can $7,105 (first and follow‐up visits, respectively, when PSA is used as prescreening). CONCLUSIONS PSA used as prescreening and followed by DRE and TRUS when PSA is abnormal is highly efficient in detecting prostate cancer at a localized (potentially curable) stage since 99% of the cancers diagnosed were at such a localized stage, thus practically eliminating the diagnosis of metastatic and noncurable prostate cancer. The approach used is highly reliable, sensitive, efficient, and acceptable by the general population. The detection of clinically nonsignificant cancer is an exception. Prostate 45:19–35, 2000. © 2000 Wiley‐Liss, Inc.

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Section: Resultssupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of prostatic specific antigen and digital rectal examination as screening tests for prostate cancer

et al. 2000

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“…The yield was also lower than with free PSA (2.1% vs 5.2% of men with PSA 3.0 -3.9 ng ml À1 ). This is consistent with the findings from a Dutch screening trial, where the specificity of DRE was 91% (Schröder et al, 1998). However, the costs for a DRE are A total of 147 screen-positive men failed to undergo biopsy and were excluded.…”

Section: Discussionsupporting

confidence: 88%

Specificity of serum prostate-specific antigen determination in the Finnish prostate cancer screening trial

et al. 2007

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Specificity constitutes a component of validity for a screening test. The number of false-positive (FP) results has been regarded as one of major shortcomings in prostate cancer screening. We estimated the specificity of serum prostate-specific antigen (PSA) determination in prostate cancer screening using data from a randomised, controlled screening trial conducted in Finland with 32 000 men in the screening arm. We calculated the specificity as the proportion of men with negative findings (screen negatives, SN) relative to those with negative and FP results (SN/(SN þ FP)). A SN finding was defined as either PSAp4 ng ml À1 or PSA 3.0 -3.9 ng ml À1 combined with a negative ancillary test (digital rectal examination, DRE or free/total, F/T PSA ratio). False positives were those with positive screening test followed by a negative diagnostic examination. Of the 30 194 eligible men, 20 794 (69%) attended the first screening round and 1968 (9.5%) had a screen-positive finding. A total of 508 prostate cancers were detected at screening (2.4%). Hence, the number of SN findings was 18 825 and the number of FP results 1358. Specificity was estimated as 0.933 (18 825 out of 20 183) with 95% confidence interval (CI) 0.929 -0.936. Specificity decreased with age. Digital rectal examination as ancillary examination had similar or higher specificity than F/T PSA. In the second screening round, specificity was slightly lower (0.912, 95% CI 0.908 -0.916). The specificity of PSA screening in the Finnish screening trial is acceptable. Further improvement in specificity could, however, improve acceptability of screening and decrease screening costs.

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“…However, the improvement has been limited due to intrinsic weaknesses in both methods. The DRE is subjective and has marginal predictive value [1][2][3], while PSA is subject to various inherent flaws, primarily driven by nonspecificity for prostate cancer. Thus, poor survival in prostate cancer results from a current lack of specific, highly predictive methods for early detection, and for differentiation of aggressive and indolent cancers.…”

Section: Introductionmentioning

confidence: 99%

Prostate cancer diagnosis in the new millennium: strengths and weaknesses of prostate‐specific antigen and the discovery and clinical evaluation of prostate cancer gene 3 (PCA3)

2009

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The decision to take a prostate biopsy is traditionally guided by a digital rectal examination and measurement of serum total prostate‐specific antigen (tPSA). However, both techniques are subject to inherent weaknesses. The prostate cancer gene 3 (PCA3), a gene‐based marker, specific for prostate cancer, supplements the predictive power of tPSA to improve diagnosis of disease. Including this new marker in the standard of care for men at risk of prostate cancer should be considered, as it presents marked potential for better decision making for a prostate biopsy and for improving overall patient care.

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Evaluation of the Digital Rectal Examination as a Screening Test for Prostate Cancer

Cited by 11 publications

References 0 publications

Evaluation of prostatic specific antigen and digital rectal examination as screening tests for prostate cancer

Evaluation of prostatic specific antigen and digital rectal examination as screening tests for prostate cancer

Specificity of serum prostate-specific antigen determination in the Finnish prostate cancer screening trial

Prostate cancer diagnosis in the new millennium: strengths and weaknesses of prostate‐specific antigen and the discovery and clinical evaluation of prostate cancer gene 3 (PCA3)

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