Harvard Radiation Oncology Program, Boston, MA, USA.
BJU Int. 2012 Dec;110(11):1636-41. doi: 10.1111/j.1464-410X.2012.11354.x. Epub 2012 Jul 3.
Study Type--Prognosis (inception cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? There is little data on the utility of digital rectal examination (DRE) as a diagnostic tool in the era of prostate-specific antigen (PSA) testing. Using a population-based database, we found that detection of prostate cancer while still localized among men with high-grade PSA-occult disease may result in survival benefit.
• To determine whether detection of high-grade prostate cancer while still clinically localised on digital rectal examination (DRE) can improve survival in men with a normal prostate-specific antigen (PSA) level.
• From the Surveillance, Epidemiology and End Results database, 166,104 men with prostate cancer diagnosed between 2004 and 2007 were identified. • Logistic regression was used to identify factors associated with the occurrence of palpable, PSA-occult (PSA level of <2.5 ng/mL), Gleason score 8-10 prostate cancer. • Fine and Gray's and Cox multivariable regressions were used to analyse whether demographic, treatment, and clinicopathological factors were associated with the risk of prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM), respectively.
• Both increasing age (adjusted odds ratio [aOR] 1.02, 95% confidence interval (CI) 1.01-1.03; P < 0.001) and White race (aOR 1.26, 95% CI 1.03-1.54; P = 0.027) were associated with palpable, Gleason 8-10 prostate cancer. Of 166,104 men, 685 (0.4%) had this subset of prostate cancer. • Significant factors associated with risk of PCSM included PSA level (adjusted hazard ratio [aHR] 0.71, 95% CI 0.51-0.99; P = 0.04), higher Gleason score (aHR 2.20, 95% CI 1.25-3.87; P = 0.006), and T3-T4 vs T2 disease (aHR 3.11, 95% CI 1.79-5.41; P < 0.001). • Significant factors associated with risk of ACM included age (aHR 1.03, 95% CI 1.01-1.06; P = 0.006), higher Gleason score (aHR 2.05, 95% CI 1.36-3.09; P < 0.001), and T3-T4 vs T2 disease (aHR 2.11, 95% CI 1.38-3.25, P < 0.001)
• Clinically localised disease on DRE among men with PSA-occult high-grade prostate cancer was associated with improved PCSM and ACM, suggesting that DRE in this cohort (older age and White race) may have the potential to improve survival.
研究类型——预后（起始队列）证据水平 2a。关于这个主题已经知道了什么？这项研究有什么新发现？在前列腺特异性抗原（PSA）检测时代，直肠指检（DRE）作为一种诊断工具的效用数据有限。本研究使用基于人群的数据库发现，在 PSA 隐匿性疾病中仍处于局限性高分级前列腺癌的男性中检测出前列腺癌可能会带来生存获益。
旨在确定在 DRE 仍能检测到局限性高分级前列腺癌是否能提高 PSA 水平正常男性的生存。
从监测、流行病学和最终结果数据库中，确定了 2004 年至 2007 年间诊断出的 166104 例前列腺癌患者。采用 logistic 回归确定与触诊、PSA 隐匿（PSA 水平<2.5ng/mL）、Gleason 评分 8-10 前列腺癌发生相关的因素。Fine 和 Gray's 和 Cox 多变量回归分别用于分析人口统计学、治疗和临床病理因素与前列腺癌特异性死亡率（PCSM）和全因死亡率（ACM）风险的相关性。
年龄（调整优势比[OR]1.02，95%置信区间[CI]1.01-1.03；P<0.001）和白种人（OR 1.26，95%CI 1.03-1.54；P=0.027）均与触诊、Gleason 8-10 前列腺癌相关。在 166104 例男性中，有 685 例（0.4%）存在这组前列腺癌。与 PCSM 风险相关的显著因素包括 PSA 水平（调整危险比[aHR]0.71，95%CI 0.51-0.99；P=0.04）、较高的 Gleason 评分（aHR 2.20，95%CI 1.25-3.87；P=0.006）和 T3-T4 期与 T2 期疾病（aHR 3.11，95%CI 1.79-5.41；P<0.001）。与 ACM 风险相关的显著因素包括年龄（aHR 1.03，95%CI 1.01-1.06；P=0.006）、较高的 Gleason 评分（aHR 2.05，95%CI 1.36-3.09；P<0.001）和 T3-T4 期与 T2 期疾病（aHR 2.11，95%CI 1.38-3.25，P<0.001）。
PSA 隐匿性高分级前列腺癌男性 DRE 触诊局限性疾病与 PCSM 和 ACM 改善相关，提示在这组患者（年龄较大和白种人）中，DRE 可能具有提高生存的潜力。
