Department of Family Medicine, McMaster University, Hamilton, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada.
Ann Fam Med. 2018 Mar;16(2):149-154. doi: 10.1370/afm.2205.
Although the digital rectal examination (DRE) is commonly performed to screen for prostate cancer, there is limited data to support its use in primary care. This review and meta-analysis aims to evaluate the diagnostic accuracy of DRE in screening for prostate cancer in primary care settings.
We searched MEDLINE, Embase, DARE (Database of Abstracts of Reviews of Effects), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from their inception to June 2016. Six reviewers, in pairs, independently screened citations for eligibility and extracted data. Pooled estimates were calculated for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DRE in primary care settings using an inverse-variance meta-analysis. We used QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) and GRADE (Grades of Recommendation Assessment, Development, and Evaluation) guidelines to assess study risk of bias and quality.
Our search yielded 8,217 studies, of which 7 studies with 9,241 patients were included after the screening process. All patients analyzed underwent both DRE and biopsy. Pooled sensitivity of DRE performed by primary care clinicians was 0.51 (95% CI, 0.36-0.67; I = 98.4%) and pooled specificity was 0.59 (95% CI, 0.41-0.76; I = 99.4%). Pooled PPV was 0.41 (95% CI, 0.31-0.52; I = 97.2%), and pooled NPV was 0.64 (95% CI, 0.58-0.70; I = 95.0%). The quality of evidence as assessed with GRADE was very low.
Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.
尽管直肠指检（DRE）常用于前列腺癌筛查，但支持其在初级保健中应用的数据有限。本综述和荟萃分析旨在评估 DRE 在初级保健环境中筛查前列腺癌的诊断准确性。
我们检索了 MEDLINE、Embase、DARE（疗效评价文摘数据库）、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库和 CINAHL（护理与联合健康文献累积索引），检索时间从建库至 2016 年 6 月。6 位评审员两两分组，独立筛选合格文献并提取数据。采用逆方差荟萃分析计算 DRE 在初级保健环境中的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）的汇总估计值。我们使用 QUADAS-2（诊断准确性研究的质量评估 2）和 GRADE（推荐评估、制定与评价分级）指南评估研究的偏倚风险和质量。
我们的检索共产生 8217 项研究，经过筛选后纳入 7 项研究，共 9241 例患者。所有分析患者均接受 DRE 和活检。由初级保健临床医生进行的 DRE 的汇总敏感性为 0.51（95%CI，0.36-0.67；I = 98.4%），汇总特异性为 0.59（95%CI，0.41-0.76；I = 99.4%）。汇总阳性预测值为 0.41（95%CI，0.31-0.52；I = 97.2%），汇总阴性预测值为 0.64（95%CI，0.58-0.70；I = 95.0%）。GRADE 评估的证据质量为极低。
鉴于支持其疗效的证据严重不足，我们建议不要在初级保健环境中常规进行 DRE 筛查前列腺癌。
