You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20112029 SHOULD A DIGITAL RECTAL EXAMINATION BE OPTIONAL FOR EARLY DETECTION OF PROSTATE CANCER IN OBESE MEN? David I. Chu, Cosimo De Nunzio, Leah Gerber, Jean-Alfred Thomas, Elizabeth Calloway, Simone Albisinni, Madeline G. McKeever, Daniel M. Moreira, Cagri Senocak, Andrea Tubaro, Judd W. Moul, Stephen J. Freedland, and Lionel L. Bañez David I. ChuDavid I. Chu Durham, NC More articles by this author , Cosimo De NunzioCosimo De Nunzio Rome, Italy More articles by this author , Leah GerberLeah Gerber Durham, NC More articles by this author , Jean-Alfred ThomasJean-Alfred Thomas Durham, NC More articles by this author , Elizabeth CallowayElizabeth Calloway Durham, NC More articles by this author , Simone AlbisinniSimone Albisinni Rome, Italy More articles by this author , Madeline G. McKeeverMadeline G. McKeever Durham, NC More articles by this author , Daniel M. MoreiraDaniel M. Moreira Durham, NC More articles by this author , Cagri SenocakCagri Senocak Ankara, Turkey More articles by this author , Andrea TubaroAndrea Tubaro Rome, Italy More articles by this author , Judd W. MoulJudd W. Moul Durham, NC More articles by this author , Stephen J. FreedlandStephen J. Freedland Durham, NC More articles by this author , and Lionel L. BañezLionel L. Bañez Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2258AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The American Cancer Society recently updated their prostate cancer (CaP) screening guidelines stating that a digital rectal exam (DRE) is now optional. Since obese men may face possible disparity in DRE testing due to their anatomic girth, we examined the impact of DRE findings on CaP detection as a function of obesity in a multi-racial multi-center cohort of men undergoing prostate biopsy. METHODS Retrospective data for men undergoing initial prostate biopsy were collected from the Duke Prostate Center (n=1145), Durham Veterans Affairs Medical Center (n=942), and La Sapienza University in Rome, Italy (n=716). Distribution of clinical parameters including DRE results were compared across body mass index (BMI) categories (<25, 25–29.9, ≥30 kg/m2) using ANOVA, Fishers exact and chi-square tests. Odds of biopsy-proven overall and high-grade (Gleason score ≥7) CaP attributed to abnormal DRE findings were estimated for each BMI group using logistic regression controlling for PSA, age, year of biopsy, and ethnicity while trend across BMI categories was analyzed using test for interaction. RESULTS In all cohorts, obese men were less likely to have an abnormal DRE than non-obese men. On multivariate analysis, an abnormal DRE was significantly associated with both overall and high-grade CaP risk in overweight and obese men in all cohorts relative to a normal DRE (see Table). Additionally, the risk for overall CaP given an abnormal DRE increased significantly across increasing BMI categories in all cohorts (p-trend≤0.05). Specifically, an abnormal DRE increased the odds of finding CaP on biopsy two- to three-fold higher among obese men than among normal-weight men. In the Italian cohort, an abnormal DRE also significantly elevated the risk of high-grade CaP in obese men relative to normal-weight men (p-trend=0.03). CONCLUSIONS Obese men are less likely to have an abnormal DRE than non-obese men. However, an abnormal DRE in an obese man portends a significantly greater risk of finding CaP and possibly high-grade CaP on biopsy than does an abnormal DRE in a normal-weight man. While performing a thorough DRE may be technically difficult in obese men, it should not be optional. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e811-e812 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information David I. Chu Durham, NC More articles by this author Cosimo De Nunzio Rome, Italy More articles by this author Leah Gerber Durham, NC More articles by this author Jean-Alfred Thomas Durham, NC More articles by this author Elizabeth Calloway Durham, NC More articles by this author Simone Albisinni Rome, Italy More articles by this author Madeline G. McKeever Durham, NC More articles by this author Daniel M. Moreira Durham, NC More articles by this author Cagri Senocak Ankara, Turkey More articles by this author Andrea Tubaro Rome, Italy More articles by this author Judd W. Moul Durham, NC More articles by this author Stephen J. Freedland Durham, NC More articles by this author Lionel L. Bañez Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...