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William J. Catalona - One of the best experts on this subject based on the ideXlab platform.

  • Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men.
    The Journal of urology, 2016
    Co-Authors: William J. Catalona, Frederick R Ahmann, Mliss A Hudson, Louis R. Kavoussi, Jean B. Dekernion, Timothy L. Ratliff, Jerome P. Richie, Robert C. Flanigan, Peter T Scardino, Bruce L Dalkin
    Abstract:

    To compare the efficacy of Digital Rectal Examination and serum prostate specific antigen (PSA) in the early detection of prostate cancer, we conducted a prospective clinical trial at 6 university centers of 6,630 male volunteers 50 years old or older who underwent PSA determination (Hybritech Tandom-E or Tandem-R assays) and Digital Rectal Examination. Quadrant biopsies were performed if the PSA level was greater than 4 μg./l. or Digital Rectal Examination was suspicious, even if transRectal ultrasonography revealed no areas suspicious for cancer. The results showed that 15% of the men had a PSA level of greater than 4 μg./l., 15% had a suspicious Digital Rectal Examination and 26% had suspicious findings on either or both tests. Of 1,167 biopsies performed cancer was detected in 264. PSA detected significantly more tumors (82%, 216 of 264 cancers) than Digital Rectal Examination (55%, 146 of 264, p = 0.001). The cancer detection rate was 3.2% for Digital Rectal Examination, 4.6% for PSA and 5.8% for the 2 methods combined. Positive predictive value was 32% for PSA and 21% for Digital Rectal Examination. Of 160 patients who underwent radical prostatectomy and pathological staging 114 (71%) had organ confined cancer: PSA detected 85 (75%) and Digital Rectal Examination detected 64 (56%, p = 0.003). Use of the 2 methods in combination increased detection of organ confined disease by 78% (50 of 64 cases) over Digital Rectal Examination alone. If the performance of a biopsy would have required suspicious transRectal ultrasonography findings, nearly 40% of the tumors would have been missed. We conclude that the use of PSA in conjunction with Digital Rectal Examination enhances early prostate cancer detection. Prostatic biopsy should be considered if either the PSA level is greater than 4 μg./l. or Digital Rectal Examination is suspicious for cancer, even in the absence of abnormal transRectal ultrasonography findings.

  • what is the role of Digital Rectal Examination in men undergoing serial screening of serum psa levels
    Nature Clinical Practice Urology, 2009
    Co-Authors: Stacy Loeb, William J. Catalona
    Abstract:

    This Practice Point commentary discusses the study by Gosselaar et al. that reports the performance characteristics of Digital Rectal Examination (DRE) in men from the Rotterdam cohort of the European Randomized Study of Screening for Prostate Cancer. The authors reported that the positive predictive value of DRE for detecting the presence of prostate cancer was 48.6% in the first round of screening, decreasing to 29.9% and 21.2% in the second and third rounds, respectively. Nevertheless, an abnormal DRE was associated with a significantly increased risk of very high-grade disease during all screening rounds, indicating that it provides useful additional prognostic information. This study adds to a considerable body of evidence supporting a role for DRE in early detection of prostate cancer.

  • characteristics of prostate cancer detected by Digital Rectal Examination only
    Urology, 2006
    Co-Authors: Onisuru T Okotie, Kimberly A Roehl, Stacy Loeb, Sara N Gashti, William J. Catalona
    Abstract:

    Objectives To examine clinical and pathologic features and postoperative survival outcomes of men with prostate cancer detected by Digital Rectal Examination (DRE) alone, elevated prostate-specific antigen (PSA) level alone, or abnormalities in both. Methods From 1989 to 2001, approximately 36,000 men participated in a prostate cancer screening study. We recommended biopsy for a PSA level greater than 4.0 ng/mL (until 1995) or greater than 2.5 ng/mL (after 1995) or DRE findings suspicious for cancer. The clinical and pathologic features were compared between patients with cancer detected by DRE alone and those with cancer detected by an elevated PSA level, regardless of DRE findings. We also evaluated progression-free survival, overall survival, and cancer-specific survival. Results Overall 303 men were diagnosed with prostate cancer by DRE alone, 1426 because of PSA level alone, and 504 by abnormal results on both tests. Of the cancers detected by DRE alone, 60 (20%) were non–organ-confined and 56 (20%) had a Gleason score of 7 or higher. Prostate cancers detected because of abnormalities in both PSA level and DRE results were significantly more likely to have adverse pathologic features, as well as lower rates of progression-free survival, overall survival, and cancer-specific survival than those detected by either test alone (all P <0.0001). Conclusions A substantial proportion of prostate cancers detected by DRE at PSA levels less than 4 ng/mL have features associated with clinically aggressive tumors. The omission of DRE from screening protocols might compromise treatment outcomes because many of the cancers detected by DRE alone are potentially curable but may have worse outcomes by the time PSA also reaches a higher level.

  • accuracy of prostate weight estimation by Digital Rectal Examination versus transRectal ultrasonography
    The Journal of Urology, 2005
    Co-Authors: Stacy Loeb, Kimberly A Roehl, Jo Ann V Antenor, William J. Catalona
    Abstract:

    ABSTRACTPurpose: The ability to estimate prostate weight is useful. Two commonly used methods for estimating prostate weight are Digital Rectal Examination (DRE) and transRectal ultrasonography (TRUS). We evaluated the relative accuracy of these weight estimates by comparing them to prostate weight following radical retropubic prostatectomy (RRP).Materials and Methods: Between 1989 and 2001 more than 36,000 community men participated in a large prostate cancer screening study. Of these men 2,238 underwent RRP. In this subset we examined the correlation between documented preoperative DRE and TRUS estimates of prostate weight with actual gland weight.Results: DRE estimates of prostate weight by multiple examiners correlated poorly with RRP specimen weight (r = 0.2743). However, TRUS estimates correlated moderately well (r = 0.6493). TRUS provided more accurate estimates of prostate weight for smaller glands, although it generally underestimated gland weight compared to the weight of the surgical specimen.C...

  • oncology prostate testis penis urethra accuracy of prostate weight estimation by Digital Rectal Examination versus transRectal ultrasonography
    2005
    Co-Authors: Stacy Loeb, Kimberly A Roehl, Jo Ann V Antenor, William J. Catalona
    Abstract:

    Purpose: The ability to estimate prostate weight is useful. Two commonly used methods for estimating prostate weight are Digital Rectal Examination (DRE) and transRectal ultrasonography (TRUS). We evaluated the relative accuracy of these weight estimates by comparing them to prostate weight following radical retropubic prostatectomy (RRP). Materials andMethods: Between 1989 and 2001more than 36,000 community men participated in a large prostate cancer screening study. Of these men 2,238 underwent RRP. In this subset we examined the correlation between documented preoperative DRE and TRUS estimates of prostate weight with actual gland weight. Results: DRE estimates of prostate weight by multiple examiners correlated poorly with RRP specimen weight (r 0.2743). However, TRUS estimates correlated moderately well (r 0.6493). TRUS provided more accurate estimates of prostate weight for smaller glands, although it generally underestimated gland weight compared to the weight of the surgical specimen. Conclusions: In a large, community based prostate cancer screening study prostate weight estimated by DRE was shown to correlate poorly with actual prostate weight. Compared with DRE, TRUS provides a better estimate of prostate weight. In addition, TRUS measurements were more accurate in smaller prostate glands.

Bruce L Dalkin - One of the best experts on this subject based on the ideXlab platform.

  • Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men.
    The Journal of urology, 2016
    Co-Authors: William J. Catalona, Frederick R Ahmann, Mliss A Hudson, Louis R. Kavoussi, Jean B. Dekernion, Timothy L. Ratliff, Jerome P. Richie, Robert C. Flanigan, Peter T Scardino, Bruce L Dalkin
    Abstract:

    To compare the efficacy of Digital Rectal Examination and serum prostate specific antigen (PSA) in the early detection of prostate cancer, we conducted a prospective clinical trial at 6 university centers of 6,630 male volunteers 50 years old or older who underwent PSA determination (Hybritech Tandom-E or Tandem-R assays) and Digital Rectal Examination. Quadrant biopsies were performed if the PSA level was greater than 4 μg./l. or Digital Rectal Examination was suspicious, even if transRectal ultrasonography revealed no areas suspicious for cancer. The results showed that 15% of the men had a PSA level of greater than 4 μg./l., 15% had a suspicious Digital Rectal Examination and 26% had suspicious findings on either or both tests. Of 1,167 biopsies performed cancer was detected in 264. PSA detected significantly more tumors (82%, 216 of 264 cancers) than Digital Rectal Examination (55%, 146 of 264, p = 0.001). The cancer detection rate was 3.2% for Digital Rectal Examination, 4.6% for PSA and 5.8% for the 2 methods combined. Positive predictive value was 32% for PSA and 21% for Digital Rectal Examination. Of 160 patients who underwent radical prostatectomy and pathological staging 114 (71%) had organ confined cancer: PSA detected 85 (75%) and Digital Rectal Examination detected 64 (56%, p = 0.003). Use of the 2 methods in combination increased detection of organ confined disease by 78% (50 of 64 cases) over Digital Rectal Examination alone. If the performance of a biopsy would have required suspicious transRectal ultrasonography findings, nearly 40% of the tumors would have been missed. We conclude that the use of PSA in conjunction with Digital Rectal Examination enhances early prostate cancer detection. Prostatic biopsy should be considered if either the PSA level is greater than 4 μg./l. or Digital Rectal Examination is suspicious for cancer, even in the absence of abnormal transRectal ultrasonography findings.

  • accuracy of Digital Rectal Examination and transRectal ultrasonography in localizing prostate cancer
    The Journal of Urology, 1994
    Co-Authors: Robert C. Flanigan, Frederick R Ahmann, Mliss A Hudson, Louis R. Kavoussi, Jean B. Dekernion, Timothy L. Ratliff, William J. Catalona, Jerome P. Richie, Peter T Scardino, Bruce L Dalkin
    Abstract:

    AbstractNot all prostate cancers are sonographically hypoechoic or palpable on Digital Rectal Examination, and suspicious areas on transRectal prostatic ultrasonography or Digital Rectal Examination often are not cancer. We present quadrant biopsy results from a multicenter prostate cancer screening study in which men were evaluated with prostate specific antigen (PSA) and Digital Rectal Examination. If the PSA level was elevated (greater than 4.0 ng./ml., Hybritech Tandem assay) or Digital Rectal Examination was suspicious quadrant biopsies were performed. Biopsy specimens were labeled separately, and histological findings were correlated by quadrant with the findings on ultrasonography and Digital Rectal Examination. Of the 6,630 subjects enrolled into the study 16% were biopsied. Of 1,002 quadrants that were suspicious on Digital Rectal Examination 110 (11%) had cancer, while 308 of 418 quadrants containing cancer (74%) were not suspicious on Digital Rectal Examination. Of 855 quadrants that were sonog...

  • Accuracy of Digital Rectal Examination and transRectal ultrasonography in localizing prostate cancer.
    The Journal of urology, 1994
    Co-Authors: Robert C. Flanigan, Frederick R Ahmann, Mliss A Hudson, Louis R. Kavoussi, Jean B. Dekernion, Timothy L. Ratliff, William J. Catalona, Jerome P. Richie, Peter T Scardino, Bruce L Dalkin
    Abstract:

    Not all prostate cancers are sonographically hypoechoic or palpable on Digital Rectal Examination, and suspicious areas on transRectal prostatic ultrasonography or Digital Rectal Examination often are not cancer. We present quadrant biopsy results from a multicenter prostate cancer screening study in which men were evaluated with prostate specific antigen (PSA) and Digital Rectal Examination. If the PSA level was elevated (greater than 4.0 ng./ml., Hybritech Tandem assay) or Digital Rectal Examination was suspicious quadrant biopsies were performed. Biopsy specimens were labeled separately, and histological findings were correlated by quadrant with the findings on ultrasonography and Digital Rectal Examination. Of the 6,630 subjects enrolled into the study 16% were biopsied. Of 1,002 quadrants that were suspicious on Digital Rectal Examination 110 (11%) had cancer, while 308 of 418 quadrants containing cancer (74%) were not suspicious on Digital Rectal Examination. Of 855 quadrants that were sonographically suspicious 153 (18%) had cancer, while 282 of 435 quadrants containing cancer (65%) were not sonographically suspicious. Of 225 patients with cancer 137 (61%) would have been missed if only the exact site of the palpable induration had been biopsied. Of 251 patients with cancer 131 (52%) would have been missed if only the exact site of the hypoechoic lesion had been biopsied. We conclude that Digital Rectal Examination and transRectal ultrasonography have limited accuracy in identifying and localizing prostate cancer. Our study emphasizes the importance of obtaining systematic biopsies if the PSA level is elevated, even in the absence of Digital Rectal Examination or ultrasound anomalies.

  • comparison of Digital Rectal Examination and serum prostate specific antigen in the early detection of prostate cancer results of a multicenter clinical trial of 6 630 men
    The Journal of Urology, 1994
    Co-Authors: William J. Catalona, Frederick R Ahmann, Mliss A Hudson, Louis R. Kavoussi, Jean B. Dekernion, Timothy L. Ratliff, Jerome P. Richie, Robert C. Flanigan, Peter T Scardino, Bruce L Dalkin
    Abstract:

    AbstractTo compare the efficacy of Digital Rectal Examination and serum prostate specific antigen (PSA) in the early detection of prostate cancer, we conducted a prospective clinical trial at 6 university centers of 6,630 male volunteers 50 years old or older who underwent PSA determination (Hybritech Tandom-E or Tandem-R assays) and Digital Rectal Examination. Quadrant biopsies were performed if the PSA level was greater than 4 μg./l. or Digital Rectal Examination was suspicious, even if transRectal ultrasonography revealed no areas suspicious for cancer. The results showed that 15% of the men had a PSA level of greater than 4 μg./l., 15% had a suspicious Digital Rectal Examination and 26% had suspicious findings on either or both tests. Of 1,167 biopsies performed cancer was detected in 264. PSA detected significantly more tumors (82%, 216 of 264 cancers) than Digital Rectal Examination (55%, 146 of 264, p = 0.001). The cancer detection rate was 3.2% for Digital Rectal Examination, 4.6% for PSA and 5.8%...

  • effect of patient age on early detection of prostate cancer with serum prostate specific antigen and Digital Rectal Examination
    Urology, 1993
    Co-Authors: Jerome P. Richie, Frederick R Ahmann, Mliss A Hudson, Louis R. Kavoussi, Jean B. Dekernion, Timothy L. Ratliff, William J. Catalona, Robert C. Flanigan, Peter T Scardino, Bruce L Dalkin
    Abstract:

    This study was designed to determine the effects of age by decade on the efficacy of Digital Rectal Examination (DRE) and serum prostate-specific antigen (PSA) for early detection of prostate cancer in men aged fifty and over. A prospective multicenter clinical trial was conducted at six university centers. All 6,630 male volunteers underwent a serum PSA (Hybritech, Tandem) determination and DRE. Quadrant biopsies of the prostate were performed if PSA was > 4 ng/mL or DRE suspicious. A total of 1,167 biopsies were performed, and 264 cancers were detected. The cancer detection rate increased from 3 percent in men aged fifty to fifty-nine to 14 percent in men eighty years or older (p or = 70, p < 0.05). Early detection programs yield a lower, yet still substantial, cancer detection rate in younger men, and there is a greater likelihood for detection of organ-confined disease in this age range. Younger men have the longest projected life expectancy and, therefore, the most to gain from early prostate cancer detection.

Noel S. Weiss - One of the best experts on this subject based on the ideXlab platform.

  • prostate cancer mortality in relation to screening by prostate specific antigen testing and Digital Rectal Examination a population based study in middle aged men
    Cancer Causes & Control, 2007
    Co-Authors: Ilir Agalliu, Janet L Stanford, Noel S. Weiss
    Abstract:

    Background Although prostate cancer screening by measurement of serum prostate-specific antigen (PSA) and Digital Rectal Examination (DRE) is common in clinical practice, the impact of such screening on prostate cancer-specific mortality remains uncertain.

  • screening by prostate specific antigen and Digital Rectal Examination in relation to prostate cancer mortality a case control study
    Epidemiology, 2005
    Co-Authors: Sheila Weinmann, Kathryn Richertboe, Stephen K Van Den Eeden, Shelley M Enger, Benjamin A Rybicki, Jean A Shapiro, Noel S. Weiss
    Abstract:

    Background: The potential role of prostate cancer screening in reducing mortality is uncertain. To examine whether screening with the prostate-specific antigen (PSA) test or Digital Rectal Examination is associated with reduced prostate cancer mortality, we conducted a population-based case–control study in 4 health maintenance organizations. Methods: Cases were 769 health plan members who died because of prostate adenocarcinoma during the years 1997–2001. We randomly selected 929 controls from the health plan membership and matched them to cases on health plan, age, race, and membership history. Medical records were used to document all screening tests in the 10 years before and including the date on which prostate cancer was first suspected. Results: Among white participants, 62% of cases and 69% of controls had a least 1 screening PSA test or Digital Rectal Examination (odds ratio = 0.73; 95% confidence interval = 0.55–0.97). The corresponding proportions for blacks were 59% and 61% (1.0; 0.59–1.4). Most screening tests were Digital Rectal Examinations; therefore, in the subgroup with no history of PSA screening, the association between Digital Rectal screening and prostate cancer mortality was similar to the overall association (0.65 [0.48–0.88] among whites; 0.86 [0.53–1.4] among blacks). Very few men received screening PSA without screening Digital Rectal Examination (6% of cases and 7% of controls among whites). Conclusions: Digital Rectal screening was associated with a reduced risk of death due to prostate cancer in our population. Because of several data limitations, this study could not accurately estimate the effect of PSA screening separate from Digital Rectal Examination.

  • Screening Digital Rectal Examination and prostate cancer mortality: A case-control study
    Journal of Medical Screening, 1998
    Co-Authors: Kathryn E. Richert-boe, Linda Humphrey, Andrew G Glass, Noel S. Weiss
    Abstract:

    Background Prostate cancer is the second most common cause of death from cancer in men in the United States. Digital Rectal Examination is the oldest and most commonly used screening test for prostate cancer, but as yet there are no studies which demonstrate its effectiveness.Methods A case-control study was conducted among members of a large health maintenance organisation to estimate the effect of screening Digital Rectal Examination on mortality from prostate cancer. 150 men, aged 40–84 when cancer was diagnosed, who developed fatal prostate cancer, and 299 male controls matched for age who did not die from prostate cancer were studied. A history of screening Digital Rectal Examination during the 10 years before the date on which cancer was diagnosed was determined from medical records.Results A similar proportion of men who died from prostate cancer and controls had undergone at least one screening Digital Rectal Examination during the 10 year interval (odds ratio = 0.84, 95% confidence interval 0.48 ...

Peter T Scardino - One of the best experts on this subject based on the ideXlab platform.

  • Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men.
    The Journal of urology, 2016
    Co-Authors: William J. Catalona, Frederick R Ahmann, Mliss A Hudson, Louis R. Kavoussi, Jean B. Dekernion, Timothy L. Ratliff, Jerome P. Richie, Robert C. Flanigan, Peter T Scardino, Bruce L Dalkin
    Abstract:

    To compare the efficacy of Digital Rectal Examination and serum prostate specific antigen (PSA) in the early detection of prostate cancer, we conducted a prospective clinical trial at 6 university centers of 6,630 male volunteers 50 years old or older who underwent PSA determination (Hybritech Tandom-E or Tandem-R assays) and Digital Rectal Examination. Quadrant biopsies were performed if the PSA level was greater than 4 μg./l. or Digital Rectal Examination was suspicious, even if transRectal ultrasonography revealed no areas suspicious for cancer. The results showed that 15% of the men had a PSA level of greater than 4 μg./l., 15% had a suspicious Digital Rectal Examination and 26% had suspicious findings on either or both tests. Of 1,167 biopsies performed cancer was detected in 264. PSA detected significantly more tumors (82%, 216 of 264 cancers) than Digital Rectal Examination (55%, 146 of 264, p = 0.001). The cancer detection rate was 3.2% for Digital Rectal Examination, 4.6% for PSA and 5.8% for the 2 methods combined. Positive predictive value was 32% for PSA and 21% for Digital Rectal Examination. Of 160 patients who underwent radical prostatectomy and pathological staging 114 (71%) had organ confined cancer: PSA detected 85 (75%) and Digital Rectal Examination detected 64 (56%, p = 0.003). Use of the 2 methods in combination increased detection of organ confined disease by 78% (50 of 64 cases) over Digital Rectal Examination alone. If the performance of a biopsy would have required suspicious transRectal ultrasonography findings, nearly 40% of the tumors would have been missed. We conclude that the use of PSA in conjunction with Digital Rectal Examination enhances early prostate cancer detection. Prostatic biopsy should be considered if either the PSA level is greater than 4 μg./l. or Digital Rectal Examination is suspicious for cancer, even in the absence of abnormal transRectal ultrasonography findings.

  • comparison of endoRectal magnetic resonance imaging guided prostate biopsy and Digital Rectal Examination in the preoperative anatomical localization of prostate cancer
    The Journal of Urology, 2005
    Co-Authors: Michael Mullerad, Hedvig Hricak, Kentaro Kuroiwa, Darko Pucar, Hui Ni Chen, Michael W Kattan, Peter T Scardino
    Abstract:

    ABSTRACTPurpose: We compared the accuracy of endoRectal magnetic resonance imaging (erMRI), transRectal ultrasound (TRUS) guided biopsy and Digital Rectal Examination (DRE) for detecting the location of cancer in the prostate gland and seminal vesicles.Materials and Methods: This is a retrospective study of 106 consecutive patients with prostate cancer who were referred for erMRI before radical prostatectomy. Step-section pathological data and erMRI were available in 90 patients, DRE data were available on 86 and individually labeled sextant core biopsies were available in 45. T1 and T2-weighted erMRI was interpreted by a single reader, who scored the likelihood of tumor on a 5-point scale in each seminal vesicle and in 12 locations in the prostate gland. MR spectroscopy data were not used for erMRI interpretation. One pathologist reviewed whole mount serial sections of radical prostatectomy specimens. The area under ROC curves was used to evaluate accuracy.Results: The area under ROC curves for tumor loc...

  • transRectal ultrasound versus Digital Rectal Examination for the staging of carcinoma of the prostate results of a prospective multi institutional trial
    The Journal of Urology, 1997
    Co-Authors: Joseph A. Smith, Peter T Scardino, Alberto Hernandez, Steven C Rose, Martin I. Resnick, Marlene J Egger
    Abstract:

    ABSTRACTPurpose: We determined the accuracy of transRectal ultrasonography versus Digital Rectal Examination in staging the local extent of biopsy proved carcinoma of the prostate.Materials and Methods: A National Institutes of Health funded network was developed to perform prospective, multi-institutional trials. A total of 386 patients judged by the investigators to be candidates for radical prostatectomy underwent transRectal ultrasonography with recording of data according to a numerical analog for construction of receiver operating characteristic curves. The results of Digital Rectal Examination were similarly recorded. After radical prostatectomy whole mount histology was performed on all surgical specimens, and pathological findings were correlated with preoperative transRectal ultrasound and Digital Rectal Examination results.Results: The calculated area under the curve for transRectal ultrasound in predicting extra-capsular tumor extension was 0.69 compared to 0.72 for Digital Rectal Examination ...

  • accuracy of Digital Rectal Examination and transRectal ultrasonography in localizing prostate cancer
    The Journal of Urology, 1994
    Co-Authors: Robert C. Flanigan, Frederick R Ahmann, Mliss A Hudson, Louis R. Kavoussi, Jean B. Dekernion, Timothy L. Ratliff, William J. Catalona, Jerome P. Richie, Peter T Scardino, Bruce L Dalkin
    Abstract:

    AbstractNot all prostate cancers are sonographically hypoechoic or palpable on Digital Rectal Examination, and suspicious areas on transRectal prostatic ultrasonography or Digital Rectal Examination often are not cancer. We present quadrant biopsy results from a multicenter prostate cancer screening study in which men were evaluated with prostate specific antigen (PSA) and Digital Rectal Examination. If the PSA level was elevated (greater than 4.0 ng./ml., Hybritech Tandem assay) or Digital Rectal Examination was suspicious quadrant biopsies were performed. Biopsy specimens were labeled separately, and histological findings were correlated by quadrant with the findings on ultrasonography and Digital Rectal Examination. Of the 6,630 subjects enrolled into the study 16% were biopsied. Of 1,002 quadrants that were suspicious on Digital Rectal Examination 110 (11%) had cancer, while 308 of 418 quadrants containing cancer (74%) were not suspicious on Digital Rectal Examination. Of 855 quadrants that were sonog...

  • Accuracy of Digital Rectal Examination and transRectal ultrasonography in localizing prostate cancer.
    The Journal of urology, 1994
    Co-Authors: Robert C. Flanigan, Frederick R Ahmann, Mliss A Hudson, Louis R. Kavoussi, Jean B. Dekernion, Timothy L. Ratliff, William J. Catalona, Jerome P. Richie, Peter T Scardino, Bruce L Dalkin
    Abstract:

    Not all prostate cancers are sonographically hypoechoic or palpable on Digital Rectal Examination, and suspicious areas on transRectal prostatic ultrasonography or Digital Rectal Examination often are not cancer. We present quadrant biopsy results from a multicenter prostate cancer screening study in which men were evaluated with prostate specific antigen (PSA) and Digital Rectal Examination. If the PSA level was elevated (greater than 4.0 ng./ml., Hybritech Tandem assay) or Digital Rectal Examination was suspicious quadrant biopsies were performed. Biopsy specimens were labeled separately, and histological findings were correlated by quadrant with the findings on ultrasonography and Digital Rectal Examination. Of the 6,630 subjects enrolled into the study 16% were biopsied. Of 1,002 quadrants that were suspicious on Digital Rectal Examination 110 (11%) had cancer, while 308 of 418 quadrants containing cancer (74%) were not suspicious on Digital Rectal Examination. Of 855 quadrants that were sonographically suspicious 153 (18%) had cancer, while 282 of 435 quadrants containing cancer (65%) were not sonographically suspicious. Of 225 patients with cancer 137 (61%) would have been missed if only the exact site of the palpable induration had been biopsied. Of 251 patients with cancer 131 (52%) would have been missed if only the exact site of the hypoechoic lesion had been biopsied. We conclude that Digital Rectal Examination and transRectal ultrasonography have limited accuracy in identifying and localizing prostate cancer. Our study emphasizes the importance of obtaining systematic biopsies if the PSA level is elevated, even in the absence of Digital Rectal Examination or ultrasound anomalies.

Jonathan Shoag - One of the best experts on this subject based on the ideXlab platform.

  • use of Digital Rectal Examination as an adjunct to prostate specific antigen in the detection of clinically significant prostate cancer
    The Journal of Urology, 2017
    Co-Authors: Joshua Alexander Halpern, Clara Oromendia, Jonathan Shoag, Sameer Mittal, Michael F Cosiano, Andrew J Vickers, Karla V Ballman, Jim C Hu
    Abstract:

    Purpose: Guidelines from the NCCN® (National Comprehensive Cancer Network®) advocate Digital Rectal Examination screening only in men with elevated prostate specific antigen. We investigated the effect of prostate specific antigen on the association of Digital Rectal Examination and clinically significant prostate cancer in a large American cohort.Materials and Methods: We evaluated the records of the 35,350 men who underwent Digital Rectal Examination in the screening arm of the Prostate, Lung, ColoRectal and Ovarian Cancer Screening trial for the development of clinically significant prostate cancer (Gleason 7 or greater). Followup was 343,273 person-years. The primary outcome was the rate of clinically significant prostate cancer among men with vs without suspicious Digital Rectal Examination. We performed competing risks regression to evaluate the interaction between time varying suspicious Digital Rectal Examination and prostate specific antigen.Results: A total of 1,713 clinically significant prosta...

  • prognostic significance of Digital Rectal Examination and prostate specific antigen in the prostate lung coloRectal and ovarian plco cancer screening arm
    The Journal of Urology, 2017
    Co-Authors: Joshua Halpern, Clara Oromendia, Jonathan Shoag, Sameer Mittal, Paul L Nguyen, Ya Chen Tina Shih, Jason D. Wright, Dawn L. Hershman, Karla V Ballman, Jim C Hu
    Abstract:

    Purpose: The absence of definitive data or explicit guidelines regarding the use of Digital Rectal Examination for prostate cancer screening may lead to confusion for physicians and patients alike. We evaluated the prognostic value of abnormal Digital Rectal Examination and prostate specific antigen following the widespread dissemination of prostate specific antigen testing in the U.S.Materials and Methods: Collectively, men comprising the screening arm of the PLCO cancer screening trial who underwent Digital Rectal Examination screening (35,350) were followed for 314,033 person-years. Adjusted analyses with competing risks regression were performed to assess the association of suspicious (nodularity, induration, asymmetry) Digital Rectal Examination and abnormal prostate specific antigen (4 ng/ml or greater) with the detection of clinically significant prostate cancer, prostate cancer specific mortality and overall mortality.Results: Among all screening encounters with a suspicious Digital Rectal examina...

  • prostate size nocturia and the Digital Rectal Examination a cohort study of 30 500 men
    BJUI, 2017
    Co-Authors: Benjamin V. Stone, Jonathan Shoag, Sameer Mittal, Christopher E. Barbieri, Joshua A Halpern, Patrick Lewicki, David M Golombos, Dina Bedretdinova, Bilal Chughtai, Richard K. Lee
    Abstract:

    Objectives To evaluate the utility of the Digital Rectal Examination (DRE) in estimating prostate size and the association of DRE with nocturia in a population-based cohort. Subjects and Methods We identified all men randomized to the screening arm of the Prostate, Lung, ColoRectal, and Ovarian Cancer Screening (PLCO) trial for whom DRE results were available. Men were excluded if they had a history of prostate surgery or incident prostate cancer. Prostate posterior surface area was derived from DRE sagittal and transverse estimates. Relationships between prostate posterior surface area, transRectal ultrasonography (TRUS), prostate-specific antigen (PSA) and nocturia were analysed using intraclass correlation coefficients (ICCs), Spearman's rank correlation and multivariable logistic regression. Results A total of 30 500 men met the inclusion criteria, with 103 275 screening visits containing paired DRE and PSA data. Digital Rectal Examination posterior surface area estimates had an ICC of 0.547 (95% CI 0.541–0.554) and were significantly yet modestly correlated with elevated PSA level (rs = 0.18, P < 0.001) and TRUS prostate volume (rs = 0.32, P < 0.001). Prostate posterior surface area was significantly associated with nocturia on multivariable analysis, but was not significant in stratified analysis of men with cardiovascular risk factors (hypertension, diabetes, high body mass index, stroke). In men without these risk factors, the highest quintile of DRE posterior surface area had 22% greater odds of nocturia than the lowest quintile (odds ratio 1.216, 95% CI 1.036–1.427). Conclusions Digital Rectal Examination is a modestly accurate tool for measuring prostate volume. While DRE posterior surface area represents a statistically significant predictor of nocturia, the magnitude of effect suggests it has limited clinical utility for assessing this condition, particularly in the presence of cardiovascular risk factors.

  • decline in prostate cancer screening by primary care physicians an analysis of trends in the use of Digital Rectal Examination and prostate specific antigen testing
    The Journal of Urology, 2016
    Co-Authors: Jonathan Shoag, Sameer Mittal, Joshua Halpern, Karla V Ballman, Christopher E. Barbieri
    Abstract:

    Purpose: Prostate cancer screening by Digital Rectal Examination and prostate specific antigen testing has been routine clinical practice in the United States for the last 25 years. Recent studies have shown a national decline in prostate specific antigen testing following the USPSTF (United States Preventive Services Task Force) recommendation against routine prostate specific antigen screening. However, to our knowledge the effect of this recommendation on Digital Rectal Examination utilization remains unknown.Materials and Methods: We used NAMCS (National Ambulatory Medical Care Survey) to characterize trends in the rate of Digital Rectal Examination and prostate specific antigen testing by primary care physicians in men older than 40 years presenting for preventive care. From 2005 to 2012 NAMCS contained 3,368 such visits (unweighted) for the study of Digital Rectal Examination trends and 4,035 unweighted visits from 2002 to 2012 for the study of prostate specific antigen trends.Results: Following the...