Gosselaar C, Kranse R, Roobol M J, Roemeling S, Schröder F H
Department of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Prostate. 2008 Jun 15;68(9):985-93. doi: 10.1002/pros.20759.
To analyze to what extent the percentage of suspicious digital rectal examination (DRE) findings vary between examiners and to what extent the percentage of prostate cancers (PCs) detected in men with these suspicious findings varies between examiners.
In the first screening round of the European Randomized study of Screening for PC (ERSPC) Rotterdam, 7,280 men underwent a PSA-determination and DRE of whom 2,102 underwent prostate biopsy (biopsy indication PSA > or = 4.0 ng/ml and/or suspicious DRE and/or TRUS). Descriptive statistics of DRE-outcome per PSA-range were used to determine the observer variability of six examiners. Because this analysis did not correct properly for other predictors of a suspicious DRE (PSA-level, biopsy indication, TRUS-outcome, prostate volume and age), a logistic regression analysis controlling for these explanatory variables was performed as well.
In 2,102 men biopsied, 443 PCs were detected (PPV = 21%). For all PSA levels the percentage suspicious DRE varied between examiners from 4% to 28% and percentage PC detected in men with a suspicious DRE varied from 18% to 36%. Logistic regression analysis showed that three of six examiners considered DRE significantly more often abnormal than others (ORs 3.48, 2.80, 2.47, P < 0.001). For all examiners the odds to have PC was statistically significantly higher in case of a suspicious DRE (ORs 2.21-5.96, P < 0.05). This increased chance to find PC was not significantly observer-dependent.
Three of six examiners considered DRE significantly more often suspicious than the others. However, under equal circumstances a suspicious DRE executed by each examiner increased the chance of the presence of PC similarly.
分析直肠指检（DRE）可疑结果的百分比在检查者之间的差异程度，以及在有这些可疑结果的男性中检测出前列腺癌（PC）的百分比在检查者之间的差异程度。
在欧洲前列腺癌筛查随机研究（ERSPC）鹿特丹的第一轮筛查中，7280名男性接受了前列腺特异性抗原（PSA）检测和直肠指检，其中2102名男性接受了前列腺活检（活检指征为PSA≥4.0 ng/ml和/或直肠指检可疑和/或经直肠超声检查[TRUS]）。采用每个PSA范围的直肠指检结果的描述性统计来确定六位检查者的观察者变异性。由于该分析未对直肠指检可疑的其他预测因素（PSA水平、活检指征、经直肠超声检查结果、前列腺体积和年龄）进行适当校正，因此还进行了控制这些解释变量的逻辑回归分析。
在2102名接受活检的男性中，检测出443例前列腺癌（阳性预测值=21%）。对于所有PSA水平，直肠指检可疑的百分比在检查者之间为4%至28%，在直肠指检可疑的男性中检测出前列腺癌的百分比为18%至36%。逻辑回归分析显示，六位检查者中有三位认为直肠指检异常的频率明显高于其他检查者（比值比分别为3.48、2.80、2.47，P<0.001）。对于所有检查者，直肠指检可疑时患前列腺癌的几率在统计学上显著更高（比值比为2.21 - 5.96，P<0.05）。这种发现前列腺癌几率的增加与观察者无显著相关性。
六位检查者中有三位认为直肠指检可疑的频率明显高于其他检查者。然而，在相同情况下，每位检查者进行的可疑直肠指检增加存在前列腺癌的几率类似。
