2030 THE ADDED VALUE OF DIGITAL RECTAL EXAMINATION IN PROSTATE CANCER SCREENING AND OUTCOMES

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20112030 THE ADDED VALUE OF DIGITAL RECTAL EXAMINATION IN PROSTATE CANCER SCREENING AND OUTCOMES Phillip Pierorazio, and Patrick Walsh Phillip PierorazioPhillip Pierorazio Baltimore, MD More articles by this author , and Patrick WalshPatrick Walsh Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2259AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The role of digital rectal examination (DRE) in prostate cancer (PC) screening has been called into question. The American Cancer Society (ACS) recommends PC screening with serial PSA with or without DRE. We evaluate the influence of DRE on outcomes of men with PC undergoing radical prostatectomy (RP) in low to normal ranges of PSA testing. METHODS The Johns Hopkins RP Database was queried for men in the PSA era (1993-present) with a PSA in the “low-normal” range (0–4.0 ng/mL) with a documented DRE; 4,270 men were identified. Cancer diagnosis was prompted by clinical examination (DRE) or PSA kinetics with consideration for patient age and family history of PC. Patient demographic and PC characteristics were compared between those men with a normal DRE (cT1c) and those with palpable disease (≥cT2) and those with cT2a disease only. Biochemical-free (BFS) and cancer-specific survival (CSS) were calculated using the Kaplan-Meier method and log-rank test. Analyses were repeated for those men with a PSA 0–2.5 and from 2.5–4.0. RESULTS 2,495 (64.0%) men were cT1c. 1,405 (36.0%) men had palpable DRE: 1,066 (75.9%) cT2a, 291 (20.7%) cT2b, 34 (2.4%) cT2c and 14 (0.4%) were cT3. Men with palpable DRE (≥cT2) had a greater proportion of Gleason 7–10 on biopsy (28.6 vs. 14.9%, p<0.001) and at RP (35.8 vs. 21.6%, p<0.001); fewer men with organ-confined PC (71.6% vs. 86.3%, p<0.001) and more positive surgical margins (10.0 vs. 6.7%, p<0.001) when compared to cT1c. Differences in biopsy and RP Gleason sum, pathological stage and surgical margin status were preserved when PSA was restricted from 0–2.5ng/mL and from >2.5–4.0ng/mL (p<0.001 for all interactions). 10-year BFS for men with cT1c, ≥cT2 and cT2a was 93.5, 85.8 and 91.1% respectively (p≤.04). 10-year CSS for men with cT1c, ≥cT2 and cT2a was 98.8, 93.8 and 96.8% (p0.01) respectively. There was no difference in BFS or CSS based on clinical stage for men with PSA 0–2.5. For men with PSA >2.5–4.0, 10-year BFS for men with cT1c, ≥cT2 and cT2a was 94.9, 84.2 and 90.3% (p≤.005) respectively. For men with PSA >2.5–4.0, 10-year CSS for men with cT1c, ≥cT2 and cT2a was 100, 94.1 and 95.2% (p≤0.002) respectively. CONCLUSIONS For men with a PSA 0–4.0ng/mL, a positive DRE was associated with a higher Gleason sum at biopsy and at RP; higher pathological stage and more positive surgical margins. In addition, men with cT1c had a better BFS and CSS at 10-years when compared to all men with a palpable DRE abnormality and those with cT2a only. DRE provides important information regarding grading, staging and outcome following RP in men with a PSA ≤4.0 ng/mL. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e812 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phillip Pierorazio Baltimore, MD More articles by this author Patrick Walsh Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...