MP26-20 UTILITY OF DIGITAL RECTAL EXAM FOR PROSTATE CANCER SCREENING AMONG MEN WITH LOW PSA VALUES

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (MP26)1 Sep 2021MP26-20 UTILITY OF DIGITAL RECTAL EXAM FOR PROSTATE CANCER SCREENING AMONG MEN WITH LOW PSA VALUES Callan Brownfield, Lara Harik, Keith Kowalczyk, Dattatraya Patil, Martin Sanda, Adeboye Osunkoya, and Christopher Filson Callan BrownfieldCallan Brownfield More articles by this author , Lara HarikLara Harik More articles by this author , Keith KowalczykKeith Kowalczyk More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Martin SandaMartin Sanda More articles by this author , Adeboye OsunkoyaAdeboye Osunkoya More articles by this author , and Christopher FilsonChristopher Filson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002023.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The digital rectal exam (DRE), as a component of prostate cancer screening, may have predictive value complementary to or independent of serum prostate-specific antigen (PSA) testing. We assessed the prevalence of high-grade cancer among prostate cancer patients with an abnormal DRE and PSA <4 ng/mL. METHODS: We identified prostate cancer patients diagnosed from 2010–2015 who were captured in the population-based SEER cancer registry. We excluded men <40 years old, men missing clinical stage/PSA/biopsy histology, men with distant metastasis, men with PSA >30ng/ml and men diagnosed via autopsy. The primary endpoint was Grade Group (GG) 4–5 cancer on biopsy among men with abnormal DRE (cT2+) and PSA <4 ng/mL. Bivariate testing evaluated associations between patient factors and the endpoint. A competing-risks survival model adjusted for pertinent factors of interest was constructed to estimate survival among men with GG 4–5 cancer and an abnormal DRE, comparing those with PSA < 4 ng/mL with those with PSA >4 ng/mL. RESULTS: Among 219,264 prostate cancer patients, 1,524 (0.7%) had GG 4–5 cancer with an abnormal DRE and PSA <4 ng/mL. This was more common among non-Hispanic (NH) White men (0.8% vs 0.3% NH Black, p<0.01) and older men (1.7% 85+ vs 0.7% 65-69 years, p<0.01). Men with abnormal DRE, low PSA, and GG 4–5 cancer on biopsy were more likely to have atypical histology (e.g., neuroendocrine, intraductal, etc.) (2.1% vs 0.4%, p<0.01) or have pattern 5 cancer on biopsy or prostatectomy specimen (51.8% vs 8.0%, p<0.001). Men with GG 4–5 cancer with an abnormal DRE and PSA <4 ng/mL had a higher mortality rate than those with GG 4–5 cancer, abnormal DRE, and PSA >4 ng/mL (sHR 1.19, 95% CI 0.99–1.43, p=0.06, Figure 1). CONCLUSIONS: Among prostate cancer patients, the presence of high-grade cancer in the setting of an abnormal DRE and low PSA is infrequent but associated with adverse features such as pattern 5 or intraductal histology. Men with high-grade prostate cancer detected by abnormal DRE with low PSA have worse survival compared to men with high-grade tumors in the setting of an abnormal DRE and elevated PSA. Source of Funding: ACS © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e471-e471 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Callan Brownfield More articles by this author Lara Harik More articles by this author Keith Kowalczyk More articles by this author Dattatraya Patil More articles by this author Martin Sanda More articles by this author Adeboye Osunkoya More articles by this author Christopher Filson More articles by this author Expand All Advertisement Loading ...