Gosselaar Claartje, Roobol Monique J, Roemeling Stijn, Schröder Fritz H
Department of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Eur Urol. 2008 Sep;54(3):581-8. doi: 10.1016/j.eururo.2008.03.104. Epub 2008 Apr 8.
The value of digital rectal examination (DRE) as a screening test for prostate cancer (PC) is controversial in the current prostate-specific antigen (PSA) era.
To determine (1) the additional value of a suspicious DRE for the detection of PC in men with an elevated PSA level in subsequent screenings and (2) the tumour characteristics of PCs detected in men with a suspicious DRE.
DESIGN, SETTING, PARTICIPANTS: Within the screening study, from 1997-2006 men aged 55-75 years were invited for an every 4-yr PSA determination. A PSA level > or =3.0ng/ml prompted a DRE and a transrectal ultrasound (TRUS)-guided, lateralized sextant biopsy. Throughout the three screenings of the ERSPC, Rotterdam, 5040 biopsy sessions were evaluated.
We determined the positive predictive values (PPVs) of a suspicious DRE and normal DRE, which entailed, respectively, the proportion of PCs detected in men with a suspicious DRE or normal DRE divided by, respectively, all biopsied men with a suspicious DRE or normal DRE.
At initial screening, the PPV of a suspicious DRE, in conjunction with an elevated PSA level, to detect PC was 48.6% compared to 22.4% for men with a normal DRE. Both PPVs decreased in consecutive screens: respectively, 29.9% versus 17.1% (screen 2) and 21.2% versus 18.2% (screen 3). Respectively, 71.0% (p<0.001), 68.8% (p<0.001), and 85.7% (p=0.002) of all PCs with a Gleason score >7 were detected in men with a suspicious DRE at screens 1, 2, and 3. A limitation is that only biopsied men were evaluated.
At initial and subsequent screenings, the chance of having cancer at biopsy was higher in men with a suspicious DRE compared to men with a normal DRE (to a lesser extent in subsequent screenings), and the combination of a PSA level > or =3.0ng/ml with a suspicious DRE resulted in detecting significantly more PCs with Gleason score >7. DRE may be useful in more selective screening procedures to decrease unnecessary biopsies and overdiagnosis.
在当前前列腺特异性抗原（PSA）时代，直肠指检（DRE）作为前列腺癌（PC）筛查试验的价值存在争议。
确定（1）可疑DRE对后续筛查中PSA水平升高男性检测PC的附加价值，以及（2）可疑DRE男性中检测到的PC的肿瘤特征。
设计、设置、参与者：在筛查研究中，1997年至2006年期间，邀请55至75岁的男性每4年进行一次PSA测定。PSA水平≥3.0ng/ml会促使进行DRE以及经直肠超声（TRUS）引导的侧方六分区活检。在荷兰鹿特丹ERSPC的三次筛查中，共评估了5040次活检。
我们确定了可疑DRE和正常DRE的阳性预测值（PPV），分别为可疑DRE或正常DRE男性中检测到的PC比例除以所有进行活检的可疑DRE或正常DRE男性。
在初次筛查时，可疑DRE联合PSA水平升高检测PC的PPV为48.6%，而正常DRE男性为22.4%。在连续筛查中，两个PPV均下降：分别为29.9%对17.1%（第2次筛查）和21.2%对18.2%（第3次筛查）。在第1、2和3次筛查中，Gleason评分＞7的所有PC中，分别有71.0%（p＜0.001）、68.8%（p＜0.001）和85.7%（p = 0.002）在可疑DRE男性中被检测到。局限性在于仅对进行活检的男性进行了评估。
在初次和后续筛查中，可疑DRE男性活检时患癌的几率高于正常DRE男性（在后续筛查中程度较轻），PSA水平≥3.0ng/ml与可疑DRE相结合可显著检测到更多Gleason评分＞7的PC。DRE可能有助于更具选择性的筛查程序，以减少不必要的活检和过度诊断。
