The diagnostic value of digital rectal examination in primary care for palpable rectal tumour

Background Accurate digital rectal examination (DRE) enables the early diagnosis of palpable rectal tumour. We aimed at evaluating the diagnostic value of DRE performed by general practitioners (GPs), with respect to detecting the presence of a palpable rectal tumour. Method All patients diagnosed to have a palpable rectal tumour via a 14‐day cancer referral system between May and December 2006 were identified from the colorectal database. Patients referred by GPs during the same period as having a palpable rectal tumour were also identified by reviewing the 14‐day cancer referrals. Sensitivity, specificity, positive and negative predictive value of a DRE in primary care were calculated by using these data. Results Between May and December 2006, 1069 patients were referred to the University Hospital of North Staffordshire to the 14‐day urgent colorectal cancer referral service. Of these, 108 patients were referred as having a ‘palpable rectal tumour’. Only 32 of the 108 were found to have a rectal lesion on examination in the hospital. Ten tumours were missed by GPs’ DREs. Conclusion Digital rectal examination in primary care for palpable rectal tumour has a sensitivity of 0.762, specificity of 0.917, positive predictive value of 0.296 and negative predictive value of 0.988. It is an inaccurate procedure and a poor predictor for palpable rectal tumour.     

血清PSA联合直肠指诊诊断前列腺癌的价值

目的 探讨前列腺特异性抗原(PSA)及直肠指诊(DRE)在前列腺癌诊断中的作用。方法 回顾性分析268例前列腺疾病患者的临床资料及PSA、DRE的结果。结果 经病理学确诊14例为前列腺癌,其中PSA值为4.0～9.9μg/L时有5例前列腺癌(5/13),PSA值≥10μg/L有5例前列腺癌(5/7);而DRE可疑者有6例前列腺癌(6/41)。如果单独用PSA或DRE对前列腺癌进行筛选,对前列腺癌诊断的漏诊率分别为28.6％(4/14)、57.1％(8/14),联合使用这两种方法仅有2例漏诊。结论 PSA联合DRE是临床上筛选前列腺癌的可靠方法。     

Comparison of the efficacy of digital rectal examination and transrectal ultrasonography in the diagnosis of prostatic cancer

167 patients with a mean age of 64 years underwent digital rectal examination (DRE), transrectal ultrasonography with a 7-MHz transverse and/or longitudinal transducer, followed by prostatic biopsy under ultrasound guidance. 231 biopsies were performed. 74 peripheral hypoechogenic zones were demonstrated. The sensitivity of DRE was 82% and the specificity 91%. The sensitivity and the specificity of ultrasound were respectively 69 and 83%. On 123 patients with normal DRE, 19 hypoechoic zones were detected and 2 patients had a positive biopsy (11%). On 104 patients without hypoechoic zone, 5 biopsies were positive (5%). The use of transrectal ultrasound scanning is able to multiply the number of impalpable cancer by 2, but in only 3 lobes, a hypoechogenic zone associated with a normal rectal examination was confirmed to be a cancer on biopsy. These cases represent 5.5 of the 56 positive biopsies, 4% of the hypoechogenic zones and 1.6% of the investigated patients with normal rectal examination. No impalpable cancer of 5 mm or less was detected by high resolution ultrasonography. DRE is still the most reliable examination for the diagnosis of prostatic cancer. Ultrasonography is a useful complement, particularly by allowing collection of tissue interpretable by the histologist in 100% of cases.     

Bimanual digital rectal examination for the evaluation of the nonpalpable testis

PURPOSE: In the evaluation and treatment of the nonpalpable testis open surgical exploration and laparoscopy are methods used to differentiate abdominal, infrainguinal (below the internal ring) and atrophic or absent testes. We sought to evaluate the use of bimanual digital rectal examination as an additional tool to localize the nonpalpable testis. MATERIALS AND METHODS: Forty-one consecutive patients with 45 nonpalpable testes were evaluated in a prospective fashion. Bimanual digital rectal examination was performed with the patients under general anesthesia just before diagnostic laparoscopy or open inguinal exploration. Palpability, location, length and contralateral testicular length were recorded. RESULTS: Twenty-five gonads or spermatic cords (56%) were palpable using the bimanual technique. All positive examinations were confirmed laparoscopically or by open exploration, and the majority of gonads were intra-abdominal (17 of 25, 68%). Seventeen normal appearing gonads underwent orchiopexy and 8 were removed secondary to atrophy, dysgenesis or poor position. Twenty testes (44%) were not palpated using this method. Of these gonads 10 normal appearing testes were found at exploration and underwent orchiopexy. Of the 10 remaining gonads 6 atrophic testes were removed, and 4 hemosiderin laden remnants were thought to represent "vanished testes." Overall, 26 gonads or remnants were intra-abdominal, 10 were "peeping" or canalicular and 9 were infrainguinal. The overall specificity was 100%, with a sensitivity of 60%. The positive predictive value was 100%. CONCLUSIONS: Bimanual digital rectal examination is a valuable tool in the evaluation of the nonpalpable testis, and identified the presence and position of the testis in the majority of our cases. Although sensitivity is low, when the testis is palpated by this method, diagnostic laparoscopy to localize the testis may be avoided.     

Assessment of screening for prostate cancer using the digital rectal examination

An early detection study for prostate cancer was initiated to determine the effect of routine digital rectal examinations on the stage of prostate cancer at diagnosis. A prostate biopsy was recommended if induration, asymmetry or nodules were detected on the digital examination. During a 6-year period 4,160 examinations were performed on 2,131 men more than 45 years old. A prostate biopsy was performed on 144 men and 36 malignant tumors were detected, of which 68 per cent were clinically localized. Pelvic lymph node metastases were found in 6 per cent of the surgically staged cancer patients and in 10 per cent of the patients who had a high grade tumor. Surgical staging revealed that 50 per cent of the patients with clinical stage B disease were upstaged to stage C or D1 disease. These results suggest that mass screening programs using digital examination may not add sufficient benefit over conventional medical care to warrant the expense. Definitive proof that screening can lower the mortality rate from prostate cancer can be obtained only by a prospective randomized clinical trial.     

Efficacy of digital rectal examination after radiotherapy for prostate cancer

PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: Routine digital rectal examination in patients with prostate cancer after radiotherapy may be omitted from followup protocols.     

结肠镜结合肛门指检诊断低位直肠息肉的价值探讨

目的分析肛门指检及结肠镜检中低位直肠息肉的漏诊率及漏诊息肉特征,探讨结肠镜检结合肛门指检的重要性。方法收集2012年9月至2013年5月在体检中心先后接受肛门指检及结肠镜检的244例受检者,分别对两种方法检查低位直肠息肉的漏诊情况进行分析。结果89例发现直肠息肉并切除息肉143个。65例在距离肛门〈7 cm肠段发现息肉94个,其中15例肛门指检漏诊息肉23个,29例结肠镜检漏诊息肉38个,结肠镜检的漏诊率高于肛门指检（24.5%vs 40.4%,χ2=5.460,P=0.019）。小息肉、平坦型息肉容易被漏诊;多发性息肉患者漏诊率较高;初级医师的息肉漏诊率明显高于有经验医师;肛门指检时间〈2 min者的漏诊率高于≥2 min者;结肠镜检操作时间〈35 min者的漏诊率高于≥35 min者;结肠镜检距离肛门≤3 cm的息肉的漏诊率明显高于肛门指检,差异均有统计学意义（P〈0.05）。结论结肠镜检和肛门指检均存在漏诊息肉的可能,息肉漏诊与息肉大小、形态、数目、病理以及操作医师、检查时间密切相关。结肠镜检查结合肛门指检,能降低低位直肠息肉的漏诊率。     

Finasteride improves the sensitivity of digital rectal examination for prostate cancer detection

PURPOSE: Men undergoing screening for prostate cancer are recommended to undergo digital rectal examination and prostate specific antigen measurement. We previously presented data from the Prostate Cancer Prevention Trial indicating that finasteride improves the performance characteristics of prostate specific antigen for cancer detection. In the current study we report the impact of finasteride on digital rectal examination sensitivity and specificity. MATERIALS AND METHODS: We examined the sensitivity and specificity of digital rectal examination in Prostate Cancer Prevention Trial subjects receiving finasteride or placebo who underwent prostate biopsy, had prostate specific antigen measurement and digital rectal examination within 1 year before biopsy and were on treatment at biopsy. RESULTS: Of 9,423 men in the finasteride group 4,579 and 5,112 of 9,459 in the placebo group met study evaluation requirements. Of 4,579 men in the finasteride group 695, including 264 with Gleason 7 or greater and 81 with Gleason 8 or greater, and 1,111 of 5,112 in the placebo group, including 240 with Gleason 7 or greater and 55 with Gleason 8 or greater, were diagnosed with prostate cancer. In men in the placebo and finasteride groups digital rectal examination sensitivity was greater for detecting higher grade tumors. The sensitivity of digital rectal examination was significantly greater for cancer detection in men receiving finasteride than placebo (21.3% vs 16.7%, p=0.015). Digital rectal examination sensitivity was also greater for detecting high grade (Gleason 7 or greater and 8 or greater) cancers in men receiving finasteride but this did not attain statistical significance. Digital rectal examination specificity was similar in men receiving finasteride or placebo. CONCLUSIONS: Finasteride significantly improves prostate cancer detection with digital rectal examination.     

直肠指检对PSA、F-PSA影响的研究

目的 :探讨直肠指检对前列腺特异抗原 (PSA)、游离前列腺特异抗原 (F PSA)的影响及其持续的时间。方法 :本组 5 1例 ,每例分别于直肠指检前、直肠指检后 1天、1周、4周抽取静脉血 2ml,采用放射免疫法测定PSA、F PSA。结果 :本组 5 1例直肠指检前血清PSA值为 0 .18～ 9.4μg/L ,平均2 .5 8± 2 .17μg/L ,F PSA值为0 .0 9～ 1.89μg/L ,平均0 .5 3± 0 .42 μg/L ,F/T比值为0 .0 6～ 0 .83,平均 0 .2 6± 0 .15 ;直肠指检后 1天、1周及 4周 ,PSA、F PSA及F/T比值虽然有所增高 ,但经统计学处理均无显著性意义。直肠指检前PSA <4.0 μg/L者 38例 ,PSA值平均为 1.5 0± 0 .92 μg/L ,PSA值≥4.0 μg/L者 13例 ,PSA值平均为5 .76± 1.5 4μg/L ;直肠指检后 1天、1周、4周 ,PSA、F PSA及F/T比值与检查前相比仍然没有统计学意义。结论 :只要检查过程中避免对前列腺作出强烈的挤压 ,常规的直肠指检对PSA、F PSA的影响极其轻微 ,且时间较短。     

血清前列腺特异性抗原及直肠指检与前列腺癌的相关性研究

目的 分析血清PSA、直肠指检(DRE)与前列腺癌检出率、临床分期以及病理分级的相关性. 方法 回顾性分析1997年1月至2010年12月796例PSA、DRE和病理结果完整患者的前列腺穿刺活检资料,采用Spearman相关性研究分析PSA和DRE与前列腺癌相关指标间的关系,进一步将PSA及DRE分组后进行比较. 结果 PSA与前列腺癌检出率、临床分期及病理分级相关(r=0.537,P＜0.0001;r=0.365,P＜0.0001;r=0.556,P＜0.0001);DRE结果与前列腺癌诊断率及病理分级有相关性(r=0.212,P＜0.0001;r=0.126,P=0.02).分组分析显示不同PSA水平组中前列腺癌检出率、前列腺癌分期以及Gleason评分差异有统计学意义(P＜0.05).而在相同PSA水平时,只有PSA 10.0 ～ 19.9 μg/L组和20.0～99.9μg/L组中DRE阳性和阴性患者的前列腺癌检出率差异有统计学意义(P＜0.05).相同PSA组中不同DRE结果患者的前列腺癌分期以及Gleason评分差异无统计学意义(P＞0.05). 结论 PSA水平与前列腺癌的检出率、肿瘤分期及Gleason评分有显著相关性,DRE结果仅在部分PSA水平患者中影响肿瘤检出率.     

直肠腔内超声术前诊断直肠癌的价值

目的 探讨直肠腔内超声对直肠癌的诊断价值。方法 使用常规直肠腔内超声检查的方法检查直肠的病变情况，并将检查结果与术中所见及术后病理检查结果相比较。结果 除1例直肠癌浸润深度估计过深处，余2例B超检查与手术和术后病理结果一致（符合率92．3％）。结论 直肠腔内超声在分辨肠壁各层结构和了解癌肿润深度，范围等方面有指导意义。     

Biopsy-based diagnosis of prostate cancer in 1290 patients referred for prostate examination: results according to the PSA level, digital rectal examination and ultrasonography

Authors present their retrospective study of 1290 patients referred for prostate evaluation. The risk of cancer was analysed according to PSA, rectal palpation and ultrasound examination. Among the 1290 patients, 54.8% had cancer. The risk of cancer was multiplied by 2.8 when the PSA was between the normal limit and 10 ng/ml, by 7.5 when it exceeded 10 ng/ml, by 4.0 when rectal palpation was abnormal and by 1.6 when a hypoechogenic zone was present. Although a hypoechogenic zone does not improve the detection of cancer compared to PSA and rectal palpation, an increased PSA level even lower than 10 ng/ml indicates biopsies.     

Effect of digital rectal examination on serum concentration of prostate-specific antigen.

Prostate-specific antigen (PSA) is used for screening and follow-up of patients with prostate cancer. The effect of certain diagnostic procedures on PSA serum levels is not well defined. Therefore, the effect of digital rectal examination (DRE) on PSA serum levels was investigated. No significant difference was observed in PSA values before and after DRE when blood samples were taken 1-3 min after palpation of the prostate. Kinetic studies demonstrated a significant increase in PSA values up to the factor 3.2 in 14 of 19 patients 2-6 h after DRE. In 9 of 14 cases, PSA was within the initial range 24 h after DRE. That means that a urologist is allowed to take blood samples for the determination of PSA at least within 3 min after palpating a suspicious prostate without getting false-positive results.     

Prostate cancer screening: Role of digital rectal examination and prostate-specific antigen

Background: This study was designed to determine the efficacy of digital rectal examination (DRE) and serum prostate-specific antigen (PSA) for early detection of prostate cancer in men ≥50 years of age. Methods: A prospective single-center clinical trial was conducted to screen 644 asymptomatic men, who were elicited by newspaper and radio advertisements, with DRE and PSA. Quadrant biopsy examinations of the prostate were performed if PSA >4 ng/ml or if DRE was suspicious. Results: Thirty-seven percent of the men (n=241) had an abnormality of DRE or elevated PSA. Of the 163 patients who underwent transrectal ultrasound and quadrant biopsies of the prostate, 77% had normal biopsies, 14 (8%) had prostatic intraepithelial neoplasia, and 24 (15%) had carcinoma of the prostate. PSAs ranged from 0.3 to 65.5 ng/ml, with a mean of 2.35 and a median of 1.6. Ninety-five patients had a PSA >4 ng/ml, of whom 17 had a PSA >10 ng/ml. Sensitivity of PSA was 75% and specificity 87%; for DRE the sensitivity was 75% and the specificity 69%. Clinical stage of patients who underwent radical prostatectomy was B1 in 15 and B2 in five. Fifteen of 20 patients (75%) had organ-confined disease; the other five had specimen-confined disease. No patient was found to have nodal involvement. Conclusion: The combination of PSA and DRE seems to improve the stage of diagnosis of patients with prostate cancer. Larger, randomized studies will be necessary to evaluate the effect of screening on overall survival. The results of this study were presented at the 46th annual cancer symposium of the Society of Surgical Oncology, Los Angeles, California, March 18–20, 1993.     

Significance of routine digital rectal examination in adults presenting with abdominal pain

AIM: Routine digital rectal examination (DRE) in children with abdominal pain has slowly gone out of practice but is still performed routinely in adults. This study was undertaken to assess the significance of routine DRE in adults with acute abdominal pain. PATIENTS AND METHODS: A total of 100 consecutive adults admitted to the emergency surgical unit with acute abdominal pain were studied prospectively. Following DRE, patients who were willing to participate in the study were requested to complete an anonymous questionnaire. The house officer conducted the rectal examination at admission and also completed an evaluation sheet. RESULTS: A working diagnosis of acute appendicitis in 38 patients and gastroduodenal, pancreatobiliary pathology in 24 patients was made. DRE did not alter clinical diagnosis or initial management in any of the 100 patients. Routine DRE did not detect any unrelated pathology. Of the patients, 93 wanted to know why rectal examination was required. Overall, 78 patients rated the DRE as uncomfortable. Although 43 were willing for DRE as a routine, 54 patients preferred to have the DRE at the time of other bowel tests rather than at the time of the emergency admission. CONCLUSIONS: Various routine medical procedures have given way to evidence-based practice. This study has demonstrated the limited role of routine DRE in adults with no anorectal or GI symptoms during their initial evaluation for acute abdominal pain.