Open Access

ARTICLE

The digital rectal examination (DRE) remains important – outcomes from a contemporary cohort of men undergoing an initial 12-18 core prostate needle biopsy

Ricardo Palmerola¹, Paul Smith², Vanessa Elliot², Carl T. Reese², Frank B. Mahon², Lewis E. Harpster², Nikolina Icitovic¹, Jay D. Raman^2,3

1 Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
2 Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
Address correspondence to Dr. Jay D. Raman, Penn State Milton S. Hershey Medical Center, 500 University Drive, H055, Hershey, PA 17033-0850 USA

Canadian Journal of Urology 2012, 19(6), 6542-6547.

Abstract

Introduction: Indications for prostate needle biopsy (PNB) include elevated serum prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE). We evaluated a contemporary cohort of men undergoing PNB to determine cancer detection rates when stratified by DRE status.
Materials and methods: The charts of 806 men who underwent a PNB were reviewed. Serum PSA was categorized as normal or abnormal according to age-specific criteria. A normal DRE was defined as a smooth, age-appropriate, asymmetric, or uniformly enlarged prostate. An abnormal DRE was defined by either a nodule or induration. Sensitivity, specificity, and predictive values were determined for an abnormal DRE and the diagnosis of prostate cancer.
Results: Within the cohort, 516 patients (64%) had a normal and 290 (36%) an abnormal DRE. Three hundred six (38%) men were diagnosed with prostate cancer of which 136 (44%) had an abnormal DRE. Fourteen percent of patients with prostate cancer had an isolated DRE abnormality. Furthermore, when specifically considering these 136 men with an abnormal DRE and prostate cancer, 43 (31%) had a normal age-specific PSA value. No differences in cancer detection rate were noted when stratifying by type of DRE abnormality. In this select cohort of patients undergoing prostate biopsy, an abnormal DRE had a sensitivity of 44%, specificity of 68%, positive predictive value (PPV) of 46%, and a negative predictive value (NPV) of 67% for detecting prostate cancer on biopsy.
Conclusion: Almost 50% of men in our cohort diagnosed with prostate cancer had an abnormal DRE. While only 14% of all patients with prostate cancer had an isolated DRE abnormality, 31% of these men had normal age-specific PSA values. Such observations underscore the importance of the DRE for prostate cancer screening.

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