Roehrborn C G, Girman C J, Rhodes T, Hanson K A, Collins G N, Sech S M, Jacobsen S J, Garraway W M, Lieber M M
Department of Urology, University of Texas Southwestern Medical Center, Dallas 75235-9110, USA.
Urology. 1997 Apr;49(4):548-57. doi: 10.1016/s0090-4295(97)00031-9.
To correlate prostate size estimates performed by single or multiple examiners through digital rectal examination (DRE) with volume measured by transrectal ultrasound (TRUS) and to propose measures for predicting prostate volume using DRE estimates in clinical settings.
Data from four sources were analyzed: (1) the Olmsted County community study of 397 patients examined by a single urology nurse, with TRUS measurements done by multiple examiners; (2) a community study in Stirling, Scotland, involving 480 patients with DRE and TRUS performed by one urologist; (3) baseline data from the Veterans Affairs Cooperative Study No. 359 in 1222 patients with DRE and TRUS measurements by multiple personnel at 31 centers; and (4) a clinical series of 100 men with DRE and TRUS by a single urologist.
DRE estimates and TRUS volumes were significantly correlated (r = 0.4 to 0.9), but prostate size was underestimated by 25% to 55% for men with a prostate volume over 40 mL, depending on the study, with greater variability for studies involving multiple examiners. In one study that assessed prostate dimensions by DRE, posterior surface area (SA) correlated with overall TRUS volume (r = 0.4). According to receiver operating characteristic curves, SA showed a 70% and 76% chance of correctly identifying men with prostate volume greater than 30 or 40 mL, respectively; those with larger prostates were best distinguished by SA greater than 7 cm2 (sensitivity greater than 0.74, specificity greater than 0.50).
DRE underestimates prostate size, particularly if TRUS volume is greater than 30 mL. However, DRE estimates may help identify prostates likely to be larger than certain cutpoints by TRUS. Posterior SA may be useful as a preliminary assessment when prostate size is an important predictor of therapeutic response.
通过直肠指检（DRE），将由单名或多名检查者进行的前列腺大小估计值与经直肠超声（TRUS）测量的体积进行关联，并提出在临床环境中使用DRE估计值预测前列腺体积的方法。
分析了来自四个来源的数据：（1）奥尔姆斯特德县社区研究，397名患者由一名泌尿外科护士进行检查，TRUS测量由多名检查者完成；（2）苏格兰斯特灵的一项社区研究，480名患者的DRE和TRUS由一名泌尿科医生进行；（3）退伍军人事务部合作研究359号的基线数据，1222名患者在31个中心由多名人员进行DRE和TRUS测量；（4）一名泌尿科医生对100名男性进行DRE和TRUS的临床系列研究。
DRE估计值与TRUS体积显著相关（r = 0.4至0.9），但前列腺体积超过40 mL的男性，根据研究不同，前列腺大小被低估了25%至55%，涉及多名检查者的研究变异性更大。在一项通过DRE评估前列腺尺寸的研究中，后表面积（SA）与TRUS总体积相关（r = 0.4）。根据受试者工作特征曲线，SA分别有70%和76%的机会正确识别前列腺体积大于30或40 mL的男性；前列腺较大的男性最好通过SA大于7 cm²来区分（敏感性大于0.74，特异性大于0.50）。
DRE会低估前列腺大小，特别是当TRUS体积大于30 mL时。然而，DRE估计值可能有助于识别经TRUS测量可能大于某些切点的前列腺。当前列腺大小是治疗反应的重要预测指标时，后SA可用作初步评估。
