Debo-Aina Adeoye, Martindale Alexander, Amjad Juwayriyyah, Smekal Martina, Nkwam Nkwam
Urology, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR.
Urology, King's College Hospital NHS Foundation Trust, London, GBR.
Cureus. 2024 Dec 9;16(12):e75390. doi: 10.7759/cureus.75390. eCollection 2024 Dec.
Background and objective Prostate cancer (PCA) is the most prevalent cancer among males. The National Institute for Health and Care Excellence (NICE) recommends referral to PCA diagnostic pathway based on two criteria: (1) abnormal digital rectal examination (DRE) and (2) elevated prostate-specific antigen (PSA). This study evaluates the diagnostic value of routine DRE in patients undergoing PCA assessment with pre-biopsy MRI. Methods We conducted a retrospective analysis of 436 patients on the PCA diagnostic pathway between September 2019 and June 2020, focusing on those with normal MRI [Prostate Imaging Reporting and Data System (PI-RADS) 1-2, n=147] and documented DRE results. Patients were categorised by their DRE status: normal vs. abnormal. The detection of prostate cancer and clinically significant prostate cancer (CSPC, i.e., Gleason score ≥7) was then compared between the two groups. Results The overall PCA detection rate was 10.2%, while it was 4.67% for CSPC. PCA and CSPC detection were higher with abnormal DRE (19.35% and 6.45% respectively) compared to normal DRE (7.76% and 4.31%). Among 23 patients biopsied, 65% (n=15) had PCA, with CSPC found in 30% (n=7). Of note, 61% (n=14) of biopsied patients had normal DRE, with nine PCA cases, five being CSPC, whereas 39% (n=9) with abnormal DRE had six PCA cases, two being CSPC. Statistical analysis using McNemar's test showed no significant association between DRE and PCA diagnosis (p=0.146) or CSPC (p=0.774). Even though abnormal DRE was associated with higher PCA and CSPC detection rates, this finding was not statistically significant. Conclusions Based on our findings, PCA diagnostics can be effectively performed without DRE. This finding is pertinent when performing remote PCA diagnostic consultations, and it reevaluates DRE's value within the diagnostic pathway while emphasising a PSA- and MRI-based approach.
背景与目的 前列腺癌（PCA）是男性中最常见的癌症。英国国家卫生与临床优化研究所（NICE）建议根据两个标准将患者转诊至PCA诊断流程：（1）直肠指检（DRE）异常；（2）前列腺特异性抗原（PSA）升高。本研究评估了在活检前进行MRI检查的PCA评估患者中常规DRE的诊断价值。方法 我们对2019年9月至2020年6月期间436例处于PCA诊断流程的患者进行了回顾性分析，重点关注MRI检查结果正常[前列腺影像报告和数据系统（PI-RADS）1-2级，n = 147]且有记录的DRE结果的患者。患者根据DRE状态分类：正常与异常。然后比较两组之间前列腺癌和临床显著前列腺癌（CSPC，即Gleason评分≥7）的检出情况。结果 总体PCA检出率为10.2%，而CSPC的检出率为4.67%。与DRE正常（7.76%和4.31%）相比，DRE异常时PCA和CSPC的检出率更高（分别为19.35%和6.45%）。在23例接受活检的患者中，65%（n = 15）患有PCA，30%（n = 7）患有CSPC。值得注意的是，61%（n = 14）接受活检的患者DRE正常，其中有9例PCA病例，5例为CSPC，而39%（n = 9）DRE异常的患者中有6例PCA病例，2例为CSPC。使用McNemar检验进行的统计分析显示，DRE与PCA诊断（p = 0.146）或CSPC（p = 0.774）之间无显著关联。尽管DRE异常与更高的PCA和CSPC检出率相关，但这一发现无统计学意义。结论 根据我们的研究结果，不进行DRE也可有效进行PCA诊断。这一发现对于进行远程PCA诊断咨询具有重要意义，它重新评估了DRE在诊断流程中的价值，同时强调了基于PSA和MRI的方法。
