Abstract
BackgroundProstate cancer is the most common cancer in men in the UK. NICE guidelines on recognition and referral of suspected cancer, recommend performing digital rectal examination (DRE) on patients with urinary symptoms and urgently referring if the prostate feels malignant. However, this is based on the results of one case control study, so it is not known if DRE performed in primary care is an accurate method of detecting prostate cancer.MethodsThe aim of this review is to ascertain the sensitivity, specificity, positive and negative predictive value of DRE for the detection of prostate cancer in symptomatic patients in primary care.CENTRAL, MEDLINE, EMBASE and CINAHL databases were searched in august 2015 for studies in which a DRE was performed in primary care on symptomatic patients and compared against a reference diagnostic procedure.ResultsFour studies were included with a total of 3225 patients. The sensitivity and specificity for DRE as a predictor of prostate cancer in symptomatic patients was 28.6 and 90.7%, respectively. The positive and negative predictive values were 42.3 and 84.2%, respectively.ConclusionThis review found that DRE performed in general practice is accurate, and supports the UK NICE guidelines that patients with a malignant prostate on examination are referred urgently for suspected prostate cancer. Abnormal DRE carried a 42.3% chance of malignancy, above the 3% risk threshold which NICE guidance suggests warrants an urgent referral. However this review questions the benefit of performing a DRE in primary care in the first instance, suggesting that a patient’s risk of prostate cancer based on symptoms alone would warrant urgent referral even if the DRE feels normal.
Highlights
IntroductionNational Institute for Health and Care Excellence (NICE) guidelines on recognition and referral of suspected cancer, recommend performing digital rectal examination (DRE) on patients with urinary symptoms and urgently referring if the prostate feels malignant
Prostate cancer is the most common cancer in men in the UK
All studies documented the symptoms suffered by patients with the exception of Issa [14] who used the international prostate symptom score (IPSS)
Summary
NICE guidelines on recognition and referral of suspected cancer, recommend performing digital rectal examination (DRE) on patients with urinary symptoms and urgently referring if the prostate feels malignant This is based on the results of one case control study, so it is not known if DRE performed in primary care is an accurate method of detecting prostate cancer. Evidence suggests survival is closely related to stage at diagnosis, with 100% five year survival in patients diagnosed with the earliest stage disease compared to less than 33% five year survival if diagnosed at the latest stage [1]. This suggests that early diagnosis of prostate cancer is important. Once a patient is symptomatic, there seems to be little benefit in delaying the diagnosis
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