Digital Rectal Examination In Patients Research Articles

The Value of Digital Rectal Examination (DRE) in Prostate Cancer Diagnostics.

Background and objective Prostate cancer (PCA) is the most prevalent cancer among males.The National Institute for Health and Care Excellence (NICE) recommends referral to PCA diagnostic pathway based on two criteria: (1) abnormal digital rectal examination (DRE)and (2) elevated prostate-specific antigen (PSA).This study evaluates the diagnostic value of routine DRE in patients undergoing PCA assessment with pre-biopsy MRI. Methods We conducted a retrospective analysis of 436 patients on the PCA diagnostic pathway between September 2019 and June 2020, focusing on those with normal MRI [Prostate Imaging Reporting and Data System (PI-RADS) 1-2, n=147] and documented DRE results.Patients were categorised by their DRE status: normal vs. abnormal. The detection of prostate cancer and clinically significant prostate cancer (CSPC, i.e.,Gleason score ≥7) was then compared between the two groups. Results The overall PCA detection rate was 10.2%, while it was 4.67% for CSPC.PCA and CSPC detection were higher with abnormal DRE (19.35% and 6.45% respectively) compared to normal DRE (7.76% and 4.31%). Among 23 patients biopsied, 65% (n=15) had PCA, with CSPC found in 30% (n=7). Of note, 61% (n=14) of biopsied patients had normal DRE, with nine PCA cases, five being CSPC, whereas 39% (n=9) with abnormal DRE had six PCA cases, two being CSPC. Statistical analysis using McNemar's test showed no significant association between DRE and PCA diagnosis (p=0.146) or CSPC (p=0.774). Even thoughabnormal DRE was associated with higher PCA and CSPC detection rates, this finding was not statistically significant. Conclusions Based on our findings, PCA diagnostics can beeffectively performed without DRE. This finding is pertinent when performing remote PCA diagnostic consultations, and it reevaluatesDRE'svalue within the diagnostic pathway while emphasising a PSA- and MRI-based approach.

Value of digital rectal examination in patients with suspected prostate cancer: a prospective cohort analysis study.

Digital rectal examination (DRE) is a straightforward, cost-effective, practical, and time-honored physical examination method that plays a valuable role in the detection of prostate cancer (PCa). Nevertheless, with the advent of the prostate-specific antigen (PSA) era, the necessity of performing DRE has become a subject of debate. Our aim was to investigate the diagnostic efficacy and adjunctive role of DRE in a population (Prostate Imaging Reporting and Data System (PI-RADS), PI-RADS ≥3 or PSA ≥4 ng/mL) suspected of PCa. Five hundred and ninety-seven patients with suspected PCa requiring referral for biopsy were prospectively enrolled consecutively from February 2020 to May 2021. All patients received DRE and corresponding clinical diagnosis by a urologist before biopsy. According to the collected clinical and pathological information, the diagnostic performance of DRE in different PSA stratifications, and its association with tumor location and Gleason score (GS) were statistically analyzed. Among patients with suspected cancer, the diagnostic accuracy of DRE was 63.45%. Compared with central zone or transition zone tumors, the recall rate of peripheral zone PCa with DRE-positive results was higher (65.50% vs. 34.55%). DRE-positive results were significantly correlated with GS ≥7 PCa (P<0.001), and the average GS of DRE-positive PCa patients was significantly higher than that of DRE-negative (7.92 vs. 7.11, P<0.001). DRE may help physicians further judge the necessity of biopsy in patients with elevated PSA, and preliminarily estimate the location and invasiveness of the tumor. However, it is still necessary to explore the value of DRE in a normal PSA population.

18F-FDG PET/CT in therapy response assessment: oligometastatic colorectal cancer

BackgroundColorectal cancer (CRC) is one of the most widespread cancers worldwide, leading to roughly half a million deaths yearly. The European Society for Medical Oncology defined oligometastatic CRC as a disease with few metastases affecting a small number of sites (5 or occasionally more metastases involving up to 3 sites). In addition to colonoscopy, magnetic resonance imaging (MRI), and digital rectal examination in patients with rectal cancer, response monitoring of CRC is commonly carried out by CT imaging. The use of PET for response monitoring has not been adapted into colorectal cancer guidelines until 2021. However, 18F-Fluorodeoxyglucose Positron Emission Tomography Computed Tomography (18F-FDG PET/CT) offers a higher efficiency for assessing treatment outcomes than traditional imaging. This study aims to explore the utility of 18F-FDG PET/CT imaging in the assessment of therapy response in patients with oligometastatic colorectal cancer (OMCRC).ResultsThe study comprised 79 OMCRC patients (35 and 44 patients with synchronous and metachronous metastasis respectively). In synchronous disease patients 18F-FDG PET/CT scan showed significant reduction of mean size and standardized uptake value (SUV) of the primary site lesions and the mean SUV of lymph nodes (LNs) and lung metastases (P = 0.00, 0.00,0.00, and 0.002, respectively) while, metachronous disease patients had significant reduction in the mean size and SUV of LNs (1.8 ± 0.7 & 4.7 ± 1.3 versus 1.1 ± 1.0 & 2.9 ± 3.0, P = 0.001 & 0.00 respectively) and the mean SUV of peritoneal metastases (8.7 ± 4.7 versus 6.8 ± 2.4 P = 0.00). Partial metabolic response (PMR) and stable metabolic disease (SMD) were found in more than half of the patients (58.2%). Complete metabolic response (CMR) and Progressive metabolic disease (PMD), on the other hand, were achieved in 41.8% of patients [17 (21.5%) and 16 (20.3%) patients, respectively] with substantially higher CMR rate in metachronous disease than synchronous disease [14.0 (31.8%) versus 3.0 (8.5%) patients, P = 0.015)].Conclusions18F-FDG PET/CT can be added as a valuable imaging method for identifying responders and non-responders among OMCRC patients, as it optimizes the selection of patients with CRC for local therapy and has a significant impact on directing their therapy course. Oligometastatic colorectal cancer seems to be a controllable disease with hopeful therapy outcomes, particularly for those with metachronous metastases.

1266 Digital Rectal Examination: Do You Still Put Your Foot in It If You Don’t Put Your Finger in It?

Abstract Introduction Most surgical trainees are familiar with the aphorism ‘if you don’t put your finger in it, you put your foot in it’, with regards to digital rectal examination (DRE). This commonly taught maxim, attributed to Bailey and Love in their Short Practice of Surgery, was coined to highlight the folly of neglecting DRE in patients with histories suggestive of malignant anorectal pathology. However, data are lacking on the diagnostic yield of DRE for detecting anorectal cancer in patients with lower gastrointestinal bleeding (LGIB), whilst advances in biomarker and imaging technology beg the question: is there still a role for DRE in the assessment of patients with LGIB? Method We designed a clinical coding search strategy to identify all adult patients with acute LGIB referred to general surgery at a UK university hospital from January to July 2020. Electronic patient records were interrogated to identify history and examination findings, diagnoses and clinical outcomes. Results 169 patients (median age 63 (16-94) years, 54.4% male) were identified, 74.6% (126/169) with bright red bleeding, 23.7% (40/169) with altered blood and 1.8% (3/169) with melaena. DRE was performed in 91.1% (154/169) of patients, identifying blood in 42.9% (66/154) of cases and suspicious lesions, which were subsequently confirmed as anorectal malignancy, in 1.3% (2/154). Conclusions DRE represents a possibly stigmatising and uncomfortable examination for patients and clinicians alike. These data support the utility of DRE in patients with LGIB and may inform the discussion at the bedside to facilitate the timely diagnosis of anorectal malignancy.

MP11-09 ADDED VALUE OF RADIOLOGICAL TUMOR STAGE IN PREDICTING EARLY ONCOLOGICAL OUTCOMES IN PROSTATE CANCER PATIENTS UNDERGOING RADICAL PROSTATECTOMY WITHIN CLINICAL STAGE: A STAGE-BY-STAGE ANALYSIS

MP11-09 ADDED VALUE OF RADIOLOGICAL TUMOR STAGE IN PREDICTING EARLY ONCOLOGICAL OUTCOMES IN PROSTATE CANCER PATIENTS UNDERGOING RADICAL PROSTATECTOMY WITHIN CLINICAL STAGE: A STAGE-BY-STAGE ANALYSIS

Is it possible to automatically assess pretreatment digital rectal examination documentation using natural language processing? A single-centre retrospective study

ObjectivesTo develop and test a method for automatic assessment of a quality metric, provider-documented pretreatment digital rectal examination (DRE), using the outputs of a natural language processing (NLP) framework.SettingAn electronic...

Prostate cancer screening in Primary Health Care: the current state of affairs.

This study aims to examine the current practice of General practitioners (GPs)/primary care physicians in opportunistic screening for prostate cancer (PC) by digital rectal examination(DRE) and Prostate Specific Antigen(PSA) testing and identify any difference in screening practice.Printed copies and/or electronic versions of a survey was distributed amongst 438 GPs throughout Australia in 2012. Statistical analyses (Wilcoxon rank-sum test, Fisher’s exact test or Pearson chi-square test)were performed by outcomes and GP characteristics.There were a total of 149 responses received (34%), with similar gender distribution in rural and metropolitan settings. 74% GPs believed PSA testing was at least ‘somewhat effective’ in reducing PC mortality with annual PSA screening being conducted by more GPs in the metropolitan setting compared to the rural GPs (35% vs 18.4%), while 25% of rural GPs would not advocate routine PSA screening. When examining the concordance between DRE and PSA testing by gender of GP, the male GPs reported performing PSA testing more frequently than DRE in patients between ages 40 to 69 (p = 0.011).Urology Society guidelines (77.2%) and College of GPs (73.2%) recommendations for PC screening were thought to be at least ‘somewhat useful’. Although reference ranges for PSA tests were felt to be useful, the majority (65.8%) found it easier to refer to an urologist due to the disagreements in guidelines.In conclusion, the current guidelines for PSA screening appear to cause more confusion due to their conflicting advice, leaving GPs to formulate their own practice methods, calling for an urgent need for uniform collaborative guidelines.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-0819-8) contains supplementary material, which is available to authorized users.

Digital Rectal Examination Is a Useful Tool for Identifying Patients With Dyssynergia

Dyssynergic defecation is a common cause of chronic constipation; its diagnosis requires anorectal physiological tests that are not widely available. It is not known whether digital rectal examination (DRE) can be used to identify dyssynergia. We examined the diagnostic yield of DRE in patients with dyssynergic defecation. Consecutive patients with chronic constipation (Rome III criteria, n = 209) underwent DREs, anorectal manometry analyses, balloon expulsion tests, and colonic transit studies. In the DRE, dyssynergia was identified by 2 or more of the following features: impaired perineal descent, paradoxic anal contraction, or impaired push effort; diagnostic yields were compared with physiological test results. Of the patients included in the study, 187 (87%) had dyssynergic defecation, based on standard criteria; 134 (73%) of these were identified to have features of dyssynergia, based on DREs. The sensitivity and specificity of DRE for identifying dyssynergia in patients with chronic constipation were 75% and 87%, respectively; the positive predictive value was 97%. DRE was able to identify normal resting and normal squeeze pressure in 86% and 82% of dyssynergic patients, respectively. DRE appears to be a reliable tool for identifying dyssynergia in patients with chronic constipation and detecting normal, but not abnormal, sphincter tone. DREs could facilitate the selection of appropriate patients for further physiologic testing and treatment.

State-of-the-Art of High-Resolution Anoscopy as a Tool to Manage Patients at Risk for Anal Cancer

Anal cancer is increasing in incidence in urban populations worldwide and particularly in HIV-positive men who have sex with men (MSM). The etiologic relationship of both anal and cervical cancer to human papillomavirus (HPV) is well established. The incidence of cervical cancer has decreased significantly as a result of an effective screening program. Women with abnormal cervical cytology are referred for colposcopy, which is used to identify and eradicate the cervical cancer precursors, cervical high-grade squamous intraepithelial lesions (HSIL). High-resolution anoscopy (HRA) or colposcopy of the anus and perianal area is a powerful tool to find and treat the precursors to anal cancer, anal HSIL. The approach to management and treatment of anal HSIL at the UCSF Anal Dysplasia Clinic using HRA in conjunction with anal cytology and digital rectal examination (DRE) is presented as a means to prevent anal cancer and to facilitate the early diagnosis of anal cancer. Principles of HRA, how to perform HRA, findings during HRA, and the use of HRA in the operating room are described. HRA coupled with DRE is an effective way to manage patients at risk for anal cancer. Several cases are described illustrating the practical application of HRA in managing patients with anal HSIL and diagnosing anal cancer. Increased awareness and, at the very least, performance of regular DRE in patients at risk and training more providers in HRA may help to decrease the incidence of anal cancer in populations at risk.

EFFICACY OF DIGITAL RECTAL EXAMINATION AFTER RADIOTHERAPY FOR PROSTATE CANCER

Digital rectal examination is widely performed for following patients with localized prostate cancer after definitive therapy. This examination has marginal efficacy for detecting initial prostate cancer and postoperative recurrence. To determine the efficacy of digital rectal examination in terms of new information provided after radiotherapy we analyzed the results of digital rectal examination in the followup of patients with prostate cancer after radiotherapy. We performed a nonrandomized study in 235 consecutive patients with prostate cancer followed at a large tertiary care military hospital between January 1, 1995 and December 31, 1999. All patients had been treated with prostate radiotherapy and had no evidence of metastatic disease at the first visit within that interval. Digital rectal examination was done at followup and the main outcome measure was new information provided by that examination. A total of 1,544 digital rectal examinations were performed in 1,627 visits. New information was provided by digital rectal examination in only 30% of 286 abnormal examinations, of which more than three-quarters were related to bleeding and would otherwise have been noted on routine examination by the primary care provider. All 8 persistent recurrent prostate nodules were noted in the context of increasing prostate specific antigen. Routine digital rectal examination in patients with prostate cancer after radiotherapy may be omitted from followup protocols.

Safety and efficacy of digital rectal examination in patients with acute myocardial infarction

OBJECTIVE: Digital rectal examination (DRE) is often ignored or deferred in acute myocardial infarction (AMI). The aim of this study was to determine the safety and efficacy of DRE in patients with AMI. METHODS: This was a prospective, comparative, stratified study in an inner-city teaching hospital. A total of 480 patients from intensive care and telemetry units were stratified into three groups. Group I included 160 patients with AMI in whom a DRE was performed and electrocardiographic (EKG) recordings were obtained. Group II included 155 patients with AMI in whom DRE was not done, but EKG recordings were made. Group III consisted of 165 patients without AMI in whom DRE was performed and EKG recordings were obtained. Sustained arrhythmias and vital signs were measured. RESULTS: None of the patients developed sustained arrhythmias and there was no change in vital signs. DRE resulted in the detection of several clinically significant findings. CONCLUSION: DRE was found to be safe in our stable patients with AMI.

Safety and efficacy of digital rectal examination in patients with acute myocardial infarction

Safety and efficacy of digital rectal examination in patients with acute myocardial infarction

Separation and Identification of Urinary Proteins Following Digital Rectal Examination in Patients with Benign Prostatic Hypertrophy.

Separation and Identification of Urinary Proteins Following Digital Rectal Examination in Patients with Benign Prostatic Hypertrophy.