The interobserver variability of digital rectal examination in a large randomized trial for the screening of prostate cancer

Gosselaar, Claartje; Kranse, Ries; Roobol, Monique J.; Roemeling, Stijn; Schröder, Fritz H.

doi:10.1002/pros.20759

Cited by 70 publications

(36 citation statements)

References 23 publications

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“…20 Although measurement of PSA is subject to some variability by assay 21 and day-to-day variation, 22 and assignment of Gleason score is marked by a degree of interobserver variation among pathologists, 23 these measurements are likely more reproducible than determination of clinical stage and, thus, serve as more objective markers of disease severity.…”

Section: Discussionmentioning

confidence: 99%

Minimal Impact of Clinical Stage on Prostate Cancer Prognosis Among Contemporary Patients With Clinically Localized Disease

2010

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Abbreviations and Acronyms AICPurpose: Clinical staging criteria for prostate cancer were established before the advent of widespread prostate specific antigen screening and extended biopsy templates. However, clinical stage remains commonly used in the modern era to predict prostate cancer outcomes. We hypothesize that in the context of data available from a contemporary biopsy, clinical stage no longer offers meaningful independent prognostic information for clinically localized prostate cancer. Materials and Methods:We performed an analysis of men in the CaPSURE™ database with localized (clinical stage T1 or T2) prostate cancer who underwent radical prostatectomy. The usefulness of clinical stage and other clinical parameters (prostate specific antigen, biopsy Gleason score, percent of positive biopsy cores) to predict pathological outcomes and biochemical recurrence after radical prostatectomy was assessed using univariate and multivariable analyses. Results: Of the 4,899 men in the study cohort 51.9% were classified as having T1 disease and 48.1% T2 disease. On univariate analysis clinical stages T2b and T2c were associated with pathological outcomes but only stage T2b was associated with biochemical recurrence. In contrast prostate specific antigen, biopsy Gleason score and percent of positive biopsy cores were strongly associated with recurrence and adverse pathological outcomes. On multivariable analysis clinical stage was of no use in determining pathological or biochemical outcomes. Conclusions: In a multivariable model, including serum prostate specific antigen, biopsy Gleason score and percent of positive biopsy cores, clinical stage offered no independent information in predicting biochemical recurrence. The results of this study call into question the usefulness of clinical staging criteria in risk stratifying cases of localized prostate cancer treated with radical prostatectomy.

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Section: Discussionmentioning

confidence: 99%

Minimal Impact of Clinical Stage on Prostate Cancer Prognosis Among Contemporary Patients With Clinically Localized Disease

2010

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“…Despite limitations such as assay-dependent variations in PSA [2,3], inter-observer variability of DRE [4] and the relatively low predictive values, both have remained the cornerstones in diagnosis of PCa [1].…”

Section: Introductionmentioning

confidence: 98%

Age-specific PCA3 score reference values for diagnosis of prostate cancer

et al. 2011

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“…PSA has a poor specificity for significant cancer at acceptable sensitivity thresholds [6], such that at least 60-70% of initial biopsies in men with a raised PSA are negative, and up to 45% of all cancers diagnosed (based on figures from the USA) are low-risk [3]. DRE has poor sensitivity, limited specificity and high inter-observer variability [7,8,9]. Trans-rectal Ultrasound (TRUS) is unreliable, thus 10-14 core template TRUS-biopsy is the standard of care, despite sub-optimal sensitivity with 20% false-negatives and a 30-45% risk of pathological up-staging [10,11] or down-staging [12] in those in men classified as low risk who proceed to RP.…”

Section: Introductionmentioning

confidence: 99%

The role of magnetic resonance imaging in the diagnosis and management of prostate cancer

et al. 2013

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Background• The diagnosis of prostate cancer has long been plagued by the absence of an imaging tool that reliably detects and localises significant tumours. Recent evidence suggests that multi-parametric MRI could improve the accuracy of diagnostic assessment in prostate cancer. This review serves as a background to a recent USANZ position statement. It aims to provide an overview of MRI techniques and to critically review the published literature on the clinical application of MRI in prostate cancer. Technical Aspects• The combination of anatomical (T2-weighted) MRI with at least two of the three functional MRI parameterswhich include diffusion-weighted imaging, dynamic contrast-enhanced imaging and spectroscopy -will detect greater than 90% of significant (moderate to high risk) tumours; however MRI is less reliable at detecting tumours that are small (<0.5 cc), low grade (Gleason score 6) or in the transitional zone. The higher anatomical resolution provided by 3-Tesla magnets and endorectal coils may improve the accuracy, particularly in primary tumour staging.

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The interobserver variability of digital rectal examination in a large randomized trial for the screening of prostate cancer

Abstract: Three of six examiners considered DRE significantly more often suspicious than the others. However, under equal circumstances a suspicious DRE executed by each examiner increased the chance of the presence of PC similarly.

Cited by 70 publications

References 23 publications

Minimal Impact of Clinical Stage on Prostate Cancer Prognosis Among Contemporary Patients With Clinically Localized Disease

Minimal Impact of Clinical Stage on Prostate Cancer Prognosis Among Contemporary Patients With Clinically Localized Disease

Age-specific PCA3 score reference values for diagnosis of prostate cancer

The role of magnetic resonance imaging in the diagnosis and management of prostate cancer

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