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William J Catalona - One of the best experts on this subject based on the ideXlab platform.
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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, 2016Co-Authors: William J Catalona, Robert C Flanigan, Jerome P Richie, Frederick R Ahmann, Mliss A Hudson, Peter T Scardino, Jean B Dekernion, Timothy L Ratliff, Louis R Kavoussi, Bruce L DalkinAbstract: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.
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digital Rectal Examination for detecting prostate cancer at prostate specific antigen levels of 4 ng ml or less
The Journal of Urology, 1999Co-Authors: William J Catalona, Gustavo F Carvalhal, Deborah S Smith, Douglas E Mager, Christian G RamosAbstract:AbstractPurpose: We evaluated the detection rate of prostate cancer in men with suspicious digital Rectal Examination findings and serum prostate specific antigen (PSA) 4 ng./ml. or less. We also evaluated the stage and grade of cancers detected.Materials and Methods: We screened 22,513 community volunteers by PSA testing and digital Rectal Examination at 6-month intervals. Biopsy was recommended when either test was suspicious for cancer. In the subset of 2,703 white and black men in whom PSA was 4 ng./ml. or less and digital Rectal Examination was suspicious for prostate cancer we compared compliance with biopsy recommendations, cancer detection rates, and stage and grade of cancers detected. We then correlated these results with patient age, race and serum PSA concentration. We performed multivariate logistic regression analysis to predict cancer based on clinical characteristics, and evaluated the positive predictive value of digital Rectal Examination for detecting cancer as stratified by race and PS...
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effect of digital Rectal Examination and needle biopsy on serum total and percentage of free prostate specific antigen levels
The Journal of Urology, 1997Co-Authors: David K Ornstein, Deborah S Smith, Timothy L Ratliff, Joseph W Basler, William J CatalonaAbstract:ABSTRACTPurpose: We determined the effect of digital Rectal Examination and prostatic biopsy on serum total and free prostate specific antigen (PSA) concentrations in men undergoing screening for prostate cancer.Materials and Methods: In 93 men recruited from our PSA screening program we measured the serum concentrations of total and free PSA on 3 occasions during a 30-day interval before performing digital Rectal Examination. Total and free PSA measurements were repeated 1 and 24 hours after the Rectal Examination. Serum total and free PSA also was measured immediately before, and 1 hour, 24 hours and 1 week after prostatic biopsy in 30 men.Results: Biological variation for total and free PSA was 14.7 and 14.0%, respectively. At 1 hour after Rectal Examination total and free PSA increased by more than the biological variation in 31 and 48% of the men, respectively. Increases were significantly greater in men whose initial PSA concentrations were less than 4.0 ng./ml. There was a dramatic increase in tota...
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interexaminer variability of digital Rectal Examination in detecting prostate cancer
Urology, 1995Co-Authors: Deborah S Smith, William J CatalonaAbstract:Objectives. Digital Rectal Examination (DRE) is an important method of prostate cancer detection used by primary care physicians and medical specialists to identify patients in whom a prostatic biopsy is warranted. However, there is little empirical evidence assessing the degree of interexaminer variability in the use of DRE for the detection of prostate cancer. We addressed this issue within the framework of a prostate cancer screening study.
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accuracy of digital Rectal Examination and transRectal ultrasonography in localizing prostate cancer
The Journal of Urology, 1994Co-Authors: Robert C Flanigan, William J Catalona, Jerome P Richie, Frederick R Ahmann, Mliss A Hudson, Peter T Scardino, Jean B Dekernion, Timothy L Ratliff, Louis R Kavoussi, Bruce L DalkinAbstract: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...
Bruce L Dalkin - One of the best experts on this subject based on the ideXlab platform.
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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, 2016Co-Authors: William J Catalona, Robert C Flanigan, Jerome P Richie, Frederick R Ahmann, Mliss A Hudson, Peter T Scardino, Jean B Dekernion, Timothy L Ratliff, Louis R Kavoussi, Bruce L DalkinAbstract: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.
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accuracy of digital Rectal Examination and transRectal ultrasonography in localizing prostate cancer
The Journal of Urology, 1994Co-Authors: Robert C Flanigan, William J Catalona, Jerome P Richie, Frederick R Ahmann, Mliss A Hudson, Peter T Scardino, Jean B Dekernion, Timothy L Ratliff, Louis R Kavoussi, Bruce L DalkinAbstract: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...
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Accuracy of digital Rectal Examination and transRectal ultrasonography in localizing prostate cancer.
The Journal of urology, 1994Co-Authors: Robert C Flanigan, William J Catalona, Jerome P Richie, Frederick R Ahmann, Mliss A Hudson, Peter T Scardino, Jean B Dekernion, Timothy L Ratliff, Louis R Kavoussi, Bruce L DalkinAbstract: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.
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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, 1994Co-Authors: William J Catalona, Robert C Flanigan, Jerome P Richie, Frederick R Ahmann, Mliss A Hudson, Peter T Scardino, Jean B Dekernion, Timothy L Ratliff, Louis R Kavoussi, Bruce L DalkinAbstract: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%...
Jim C Hu - One of the best experts on this subject based on the ideXlab platform.
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use of digital Rectal Examination as an adjunct to prostate specific antigen in the detection of clinically significant prostate cancer
The Journal of Urology, 2017Co-Authors: Joshua Alexander Halpern, Clara Oromendia, Jonathan Shoag, Sameer Mittal, Michael F Cosiano, Karla V Ballman, Andrew J Vickers, Jim C HuAbstract: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...
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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, 2017Co-Authors: Joshua Halpern, Clara Oromendia, Jonathan Shoag, Sameer Mittal, Karla V Ballman, Paul L Nguyen, Dawn L Hershman, Jason D Wright, Ya Chen Tina Shih, Jim C HuAbstract: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...
Rosa Burgers - One of the best experts on this subject based on the ideXlab platform.
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Rectal Examination in children digital versus transabdominal ultrasound
The Journal of Urology, 2013Co-Authors: Rosa Burgers, Tom P.v.m. De Jong, Marc A. BenningaAbstract:Purpose: We investigate 2 diagnostic tests to assess the Rectal filling state.Materials and Methods: The Rectal filling state was assessed with transabdominal ultrasound or with digital Rectal Examination by 2 independent investigators in children with urological problems before a scheduled diagnostic or surgical urological procedure. A dilated rectum filled with stool or large amounts of (usually) hard stool were both considered as a Rectal fecal mass. All investigations were performed with the patient under general anesthesia. The kappa test was used to evaluate agreement between transabdominal ultrasound and digital Rectal Examination.Results: A total of 84 children (54 boys) with a median (p25–p75) age of 9.0 years (6.4–11) were eligible candidates. A Rectal mass was found on transabdominal ultrasound and digital Rectal Examination in 32% and 41% of all children, respectively, with agreement between the 2 tests in 82.5%. Cohen's kappa showed good agreement of 0.62 (95% CI 0.45–0.79) between transabdom...
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899 Rectal Examination in Children: Digital Versus Transabdominal Ultrasound
Gastroenterology, 2012Co-Authors: Rosa Burgers, Tom P.v.m. De Jong, Marc A. BenningaAbstract:Purpose: We investigate 2 diagnostic tests to assess the Rectal filling state. Materials and Methods: The Rectal filling state was assessed with transabdominal ultrasound or with digital Rectal Examination by 2 independent investigators in children with urological problems before a scheduled diagnostic or surgical urological procedure. A dilated rectum filled with stool or large amounts of (usually) hard stool were both considered as a Rectal fecal mass. All investigations were performed with the patient under general anesthesia. The kappa test was used to evaluate agreement between transabdominal ultrasound and digital Rectal Examination. Results: A total of 84 children (54 boys) with a median (p25‐p75) age of 9.0 years (6.4‐11) were eligible candidates. A Rectal mass was found on transabdominal ultrasound and digital Rectal Examination in 32% and 41% of all children, respectively, with agreement between the 2 tests in 82.5%. Cohen’s kappa showed good agreement of 0.62 (95% CI 0.45‐0.79) between transabdominal ultrasound and digital Rectal Examination. The median (IQR) diameter of the rectum was 3.3 cm (2.8‐3.9) in children with a full rectum, and 2.5 cm (1.8‐2.8) and 2.0 cm (1.5‐2.2) in patients with a half filled and empty rectum, respectively. Conclusions: Transabdominal ultrasound is a noninvasive and reliable alternative to assess the Rectal filling state, and might replace digital Rectal Examination in the evaluation of children with constipation.
Deborah S Smith - One of the best experts on this subject based on the ideXlab platform.
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digital Rectal Examination for detecting prostate cancer at prostate specific antigen levels of 4 ng ml or less
The Journal of Urology, 1999Co-Authors: William J Catalona, Gustavo F Carvalhal, Deborah S Smith, Douglas E Mager, Christian G RamosAbstract:AbstractPurpose: We evaluated the detection rate of prostate cancer in men with suspicious digital Rectal Examination findings and serum prostate specific antigen (PSA) 4 ng./ml. or less. We also evaluated the stage and grade of cancers detected.Materials and Methods: We screened 22,513 community volunteers by PSA testing and digital Rectal Examination at 6-month intervals. Biopsy was recommended when either test was suspicious for cancer. In the subset of 2,703 white and black men in whom PSA was 4 ng./ml. or less and digital Rectal Examination was suspicious for prostate cancer we compared compliance with biopsy recommendations, cancer detection rates, and stage and grade of cancers detected. We then correlated these results with patient age, race and serum PSA concentration. We performed multivariate logistic regression analysis to predict cancer based on clinical characteristics, and evaluated the positive predictive value of digital Rectal Examination for detecting cancer as stratified by race and PS...
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effect of digital Rectal Examination and needle biopsy on serum total and percentage of free prostate specific antigen levels
The Journal of Urology, 1997Co-Authors: David K Ornstein, Deborah S Smith, Timothy L Ratliff, Joseph W Basler, William J CatalonaAbstract:ABSTRACTPurpose: We determined the effect of digital Rectal Examination and prostatic biopsy on serum total and free prostate specific antigen (PSA) concentrations in men undergoing screening for prostate cancer.Materials and Methods: In 93 men recruited from our PSA screening program we measured the serum concentrations of total and free PSA on 3 occasions during a 30-day interval before performing digital Rectal Examination. Total and free PSA measurements were repeated 1 and 24 hours after the Rectal Examination. Serum total and free PSA also was measured immediately before, and 1 hour, 24 hours and 1 week after prostatic biopsy in 30 men.Results: Biological variation for total and free PSA was 14.7 and 14.0%, respectively. At 1 hour after Rectal Examination total and free PSA increased by more than the biological variation in 31 and 48% of the men, respectively. Increases were significantly greater in men whose initial PSA concentrations were less than 4.0 ng./ml. There was a dramatic increase in tota...
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interexaminer variability of digital Rectal Examination in detecting prostate cancer
Urology, 1995Co-Authors: Deborah S Smith, William J CatalonaAbstract:Objectives. Digital Rectal Examination (DRE) is an important method of prostate cancer detection used by primary care physicians and medical specialists to identify patients in whom a prostatic biopsy is warranted. However, there is little empirical evidence assessing the degree of interexaminer variability in the use of DRE for the detection of prostate cancer. We addressed this issue within the framework of a prostate cancer screening study.