Cui Tao, Kovell R Caleb, Terlecki Ryan P
a Department of Urology , Wake Forest School of Medicine , Winston-Salem , NC , USA.
b Department of Urology , University of Pennsylvania , Philadelphia , PA , USA.
Curr Med Res Opin. 2016 Oct;32(10):1663-1669. doi: 10.1080/03007995.2016.1198312. Epub 2016 Jul 4.
In 2012 the US Preventive Services Task Force released recommendations against prostate specific antigen (PSA) based screening for prostate cancer, but did not fully address screening via digital rectal exam (DRE). As such, many practitioners continue to perform DRE in attempts to identify men with clinically significant prostate cancer (CSPC). This study seeks to determine the value of DRE in detecting CSPC in the era of PSA-based screening.
Data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial, a nationwide population-based study evaluating cancer screening programs and their impact on cancer mortality, was analyzed for PSA, DRE, and cancer status. In the screening arm of the PLCO, 38,340 men received annual PSA and DRE examinations for the first 3 years. Those with an abnormal test result were referred to their individual care provider for biopsy. The ability of DRE to detect CSPC, defined as intermediate risk or higher based on National Comprehensive Cancer Network guidelines and age ≤75, was evaluated in the context of both normal and abnormal PSA.
A total of 5064 men had abnormal DRE in the setting of normal PSA, of whom 99 (2%) were diagnosed with CSPC. When both PSA and DRE were abnormal, 218 (20%) participants were diagnosed with CSPC (RR = 2.06 [1.78-2.39] versus abnormal PSA alone).
DRE screening in the setting of normal PSA captured an additional 2% of men with CSPC. This incremental gain suggests that routine DRE screening subjects a large number of men to invasive, potentially uncomfortable examinations for relatively minimal gain. Key limitations: Our conclusions are based on data derived from the PLCO study which has been criticized on the basis of inconsistent biopsies following positive screening tests, lack of end of study biopsies to determine population disease burden, and low numbers of black men.
2012年，美国预防服务工作组发布了反对基于前列腺特异性抗原（PSA）筛查前列腺癌的建议，但未全面涉及通过直肠指检（DRE）进行的筛查。因此，许多从业者继续进行直肠指检，试图识别患有临床显著性前列腺癌（CSPC）的男性。本研究旨在确定在基于PSA筛查的时代，直肠指检在检测CSPC中的价值。
对前列腺、肺、结肠和卵巢（PLCO）筛查试验的数据进行分析，该试验是一项基于全国人群的研究，评估癌症筛查项目及其对癌症死亡率的影响，分析内容包括PSA、直肠指检和癌症状态。在PLCO的筛查组中，38340名男性在最初3年接受了年度PSA和直肠指检。检测结果异常者被转介给各自的医疗服务提供者进行活检。根据美国国立综合癌症网络指南和年龄≤75岁定义为中度风险或更高风险的CSPC，在PSA正常和异常的情况下，评估直肠指检检测CSPC的能力。
共有5064名男性在PSA正常的情况下直肠指检结果异常，其中99名（2%）被诊断为CSPC。当PSA和直肠指检均异常时，218名（20%）参与者被诊断为CSPC（相对风险=2.06[1.78 - 2.39]，单独PSA异常者相比）。
在PSA正常的情况下进行直肠指检筛查，可额外发现2%的CSPC男性。这种增量获益表明，常规直肠指检筛查会使大量男性接受侵入性、可能令人不适的检查，但获益相对较小。主要局限性：我们的结论基于PLCO研究的数据，该研究因筛查试验阳性后活检不一致、缺乏研究结束时活检以确定人群疾病负担以及黑人男性数量少而受到批评。
