Rectal Exploration: its Importance in Diagnosing Prostate Cancer

Abstract

This paper deals with the importance of rectal exploration in order to diagnose a possible prostate cancer. This article describes in details the correct procedure of rectal exploration, its preeminent importance in discovering diseases and every possible how is possible to hypothesize some disease through this exploration. For this reason, a correct rectal exploration is considered as the fastest way to identify prostate cancer (or any kind of disease), before making any other examination; actually it should be regularly done even in absence of symptoms. The rectal exploration (RE) must constitute the first diagnostic approach to the patient that presents symptoms referable to a possible prostatic pathology. Given that prostate cancer occurs in more than 70% of cases at the peripheral portion of the gland, the neoplastic nodule can often be detected already with the simple palpation. In particular, this is easier when the lesion has a volume of 0.2 mL or greater. About 18% of prostatic neoplasms are detected by rectal exploration alone, regardless of PSA values. A suspected palpatory to the RE, associated with a PSA>2ng/ml, presents a positive predictive value between 5 and 30%. An at least dubious RE is also associated with an increased risk of disease with a high Gleason score and therefore leads to taking into account the execution of post-operative biopsy. However, the RE, although indispensable in the evaluation of the patient, cannot be used singularly as the only diagnostic method, as it presents low levels of sensitivity (positive predictive value), and specificity. In large series of patients it has been shown that the ER fails the diagnosis of cancer in about half of the cases, as there is no demonstrated correspondence between a palpatory alteration and the presence of tumor.