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PubMed1994

[Evaluation of prostatic specific antigen after a digital rectal examination: experience with 36 patients].

Levels of prostatic specific antigen may be modified with procedures over the prostatic gland. We measured this antigen in 36 hospitalized patients before and immediately after a digital rectal examination. Antigen levels were 8.3 +/- 21.3 ng/ml before and 13.8 +/- 27.5 ng/ml after the examination (NS). It is concluded that digital rectal examination did not modify antigen levels in our sample.

Adult↗

PubMed1993

Prostate-specific antigen coordinated with digital rectal examination and transrectal ultrasonography in the detection of prostate cancer.

In a patient population, coordinated use of digital rectal examination and prostate-specific antigen can alert the physician as to the possible existence of prostate cancer. If both are used as first-line studies, abnormality of either can then direct the need for further study by transrectal ultrasonography and, in selected instances, prostatic biopsy. Such sequential use of these tests in a programmed manner results in an increased level of cancer detection as compared with use of the digital rectal examination alone.

Humans↗

PubMed2000

Digital rectal examination sampling of stool is less predictive of significant colorectal pathology than stool passed spontaneously.

OBJECTIVES: To compare the positivity rate and the positive predictive value of an immunochemical faecal occult blood test (FOBT) carried out by using stool samples obtained during a routine screening method and those obtained during digital rectal examination. DESIGN: Screening programme-based, cross-sectional study. METHODS: In a screening programme-based, cross-sectional study, 1,044 subjects who received both an immunochemical FOBT and colonoscopy were divided into two groups according to stool collection techniques--the routine screening method and the digital rectal examination method. The positivity rate of the immunochemical FOBT, as well as the positive predictive value for colorectal cancer and large adenomatous polyp, were determined in the two groups. RESULTS: The positivity rate and positive predictive value were 3.8% and 60.0% (10.0% for cancer and 50.0% for adenomatous polyp) in the routine screening group, and 9.4% and 26.5% (4.1% for cancer and 22.4% for adenomatous polyp) in the digital rectal examination group, respectively, indicating a significant difference in the positivity rate (P < 0.01) as well as the positive predictive value (P< 0.05) between the two groups. CONCLUSIONS: These results show that digital rectal examination sampling of stool is less predictive of significant colorectal pathology than stool passed spontaneously, and therefore the latter is the preferred method for stool sampling.

Chi-Square Distribution↗

PubMed2000

Prostate specific antigen testing and digital rectal examination before and during a randomized trial of screening for prostate cancer: European randomized study of screening for prostate cancer, Rotterdam.

PURPOSE: Worldwide 2 large-scale randomized screening trials for prostate cancer have been initiated. Determining prostate specific antigen (PSA) involves a simple test that may influence the outcome of these trials if frequently done in the control arm or before study enrollment. We quantified PSA and digital rectal examination before and during the screening trial in Rotterdam, The Netherlands and in the general population. MATERIALS AND METHODS: Trial participants were administered study intake questionnaires on tests done before study participation. Data on PSA from the regional general practice laboratory were correlated with participant data. Various sources were used to quantify PSA tests and digital rectal examinations in the general population. RESULTS: Of men 55 to 74 years old 45% underwent digital rectal examination at 1 time and 13% reported that PSA was tested before trial participation. Each rate increased with age. No statistically significant effect of former PSA testing or digital rectal examination on the cancer detection rate was identified. The rate of PSA determination after initial screening and/or randomization in the control arm was 2-fold that in the screening arm (76 versus 33/1,000 person-years). PSA determination initially decreased in the screening arm but increased rapidly after some time. The number of PSA determinations in the general population was estimated to be 45/1,000 person-years at ages 55 to 69 years. CONCLUSIONS: PSA testing was moderate in the control arm but if different men undergo this test each year, the contamination rate may become rather high. In the final analysis of mortality PSA testing should be considered.

Adult↗

PubMed1991

Comparison of the digital rectal examination, endorectal ultrasound, and body coil magnetic resonance imaging in the staging of adenocarcinoma of the prostate.

A series of 25 patients with biopsy proven adenocarcinoma of the prostate underwent preoperative staging evaluation with a digital rectal examination, endorectal ultrasound, and body coil magnetic resonance imaging (MRI) before their radical retropubic prostatectomy. The sensitivity and specificity of the digital rectal examination for the detection of extracapsular disease were 17 and 100%, respectively. The sensitivity and specificity of endorectal ultrasound for the detection of extracapsular disease were 35 and 89%, respectively. The sensitivity and specificity of body coil MRI for the detection of extracapsular disease by adenocarcinoma of the prostate were 47 and 63%, respectively. Microscopic disease of the capsule and seminal vesicles was the principle reason for understaging by both imaging modalities. This small series suggests that both imaging modalities are marginally more sensitive, albeit less specific, for extracapsular disease of the prostate than the digital rectal examination, with ultrasound having a slight edge in specificity and MRI having a slight edge in sensitivity.

Adenocarcinoma↗

PubMed1988

An evaluation of serial digital rectal examinations in screening for prostate cancer.

The purpose of this review is to test the hypothesis that serial digital rectal examinations of the prostate lead to detection of prostate cancer at an earlier and more curable stage. The clinic records of 4,843 patients between 40 and 79 years old seen at the Brooke Army Medical Center prostate cancer screening clinic between January 1979 and September 1985 were reviewed. Of the patients with palpable nodules 122 were found on biopsy to have adenocarcinoma of the prostate. We compared the clinical and, when possible, pathological stage of disease diagnosed at the initial clinical visit to those from patients who had prior normal digital rectal examinations at the screening clinic and who were followed at our clinic. There was a numerically striking difference in the percentage of patients in each group with clinical as well as pathological stage B cancer. Due to the small number of patients in each group these differences were not statistically significant.

Adenocarcinoma↗

PubMed1998

An analysis of digital rectal examination and serum-prostate-specific antigen in the early detection of prostate cancer in general practice.

BACKGROUND: Prostate cancer is now the commonest cancer in men and the second commonest cause of death from cancer. However, general-practice-based research on prostate cancer remains scanty. OBJECTIVES: We aimed to examine the acceptability of digital rectal examination (DRE) and serum-prostate-specific antigen (PSA) in the early detection of prostate cancer in a general practice setting. Another aim was to ascertain the incidence of prostate cancer among 50-79-year-old men in the solo practice. METHODS: We conducted an opportunistic, prospective, population-based study involving men with no prior, proven history of prostate cancer. RESULTS: A total of 211 (87.6%) out of 241 targeted patients agreed to take part in the study. Abnormal DREs were found in 9%, while 9.5% of PSA tests were found to be abnormal. One or both tests were abnormal in 29 patients-13.7% of the study population. Eleven biopsies were performed during the study, with cancer detected in three (27.3%)-1.4% of the total population. Eighteen patients were not biopsied either on clinical grounds or by personal choice. CONCLUSIONS: The incidence of abnormal DRE and PSA tests was lower than that detected in previous hospital or specialist-based studies. Both tests were found to be highly acceptable to the population studied. Not all patients with abnormal early detection tests need necessarily proceed to further invasive investigations.

Aged↗

PubMed1994

Alteration of maximum anal resting pressure by digital rectal examination prior to manometry: analysis of agreement between repeat measurements.

To study whether digital examination preceding anal manometry causes significant alteration of maximum resting pressure reading and to quantify the discrepancies, 78 individuals (64 incontinent, 14 controls) were investigated. Recordings of maximum resting pressure were taken before and after digital rectal examination. There was a mean discrepancy of only -1.8 cms H2O between the readings and excellent correlation, but analysis of agreement revealed a bias that tended to be greater with smaller measurements and unacceptable variability between test results. Furthermore, the bias was not related to age, gender, the grade of incontinence, maximum voluntary contraction, functional anal canal length and threshold volume. Digital rectal examination prior to manometry causes unpredictable results especially in patients with lower maximum resting pressures and should strictly be avoided.

Adult↗

PubMed1997

The effect of digital rectal examination, flexible cystoscopy and prostatic biopsy on free and total prostate specific antigen, and the free-to-total prostate specific antigen ratio in clinical practice.

PURPOSE: We evaluated the effects of common urological maneuvers on serum free prostate specific antigen (PSA) and established guidelines for clinical practice. MATERIALS AND METHODS: Total and free PSA, and free-to-total PSA ratio were determined in 82 men with lower urinary tract symptoms before and 30 minutes after 3 different prostatic manipulations: 1) digital rectal examination (36 cases), 2) flexible cystoscopy (26) and 3) transrectal ultrasound guided prostatic biopsy (20). PSA forms were measured with Hybritech Tandem-R assays. RESULTS: Cystoscopy had no effect on total PSA, while digital rectal examination had a slight, statistically significantly positive effect and biopsy uniformly increased total PSA (geometric mean ratio 2.43, t = 5.08, p <0.001). Free PSA was increased by digital rectal examination (geometric mean ratio 1.67, t = 4.25, p <0.001), prostatic biopsy (geometric mean ratio 4.80, t = 7.48, p <0.001) and cystoscopy (geometric mean ratio 1.21, t = 2.51, p = 0.019). There was a significant increase in free-to-total PSA ratio after each maneuver. The rate of change in free PSA and free-to-total PSA ratio after biopsy differed between patients with benign and malignant histological findings. CONCLUSIONS: Free PSA and free-to-total PSA ratios are altered by all forms of prostatic manipulation. The PSA response to manipulation may be different in patients with prostatic malignancy. Phlebotomy must precede digital rectal examination in the clinical and research setting to avoid misleading results.

Adult↗

PubMed1992

Prostate-specific antigen: establishment of the reference range for the clinically normal prostate gland and the effect of digital rectal examination, ejaculation, and time on serum concentrations.

This study investigated the serum prostate-specific antigen concentration in 100 healthy men (mean age, 26.3 years; range, 20-29 years) with a clinically normal prostate gland. The effect of digital rectal examination and ejaculation on the serum concentration, and the variability of the serum concentration over 1-week and 1-month periods were examined. In the 100 subjects, the serum prostate-specific antigen concentration ranged from less than 0.1-2.6 ng/ml. The mean, median, and mode were 0.68 ng/ml, 0.6 ng/ml, and 0.4 ng/ml, respectively. The 97.5th percentile value was 2.1 ng/ml. The mean and median changes in the serum concentration after digital rectal examination were -0.013 +/- 0.11 ng/ml and 0.0 ng/ml, respectively (P = 0.59 compared with control group). The mean change after ejaculation was 0.05 +/- 0.12 ng/ml, and the median change was 0.0 ng/ml (P = 0.14 compared with control group). Diurnal variation showed minimal change in 16 patients over a 1-week period. The mean change (p.m. value-a.m. value) was 0.003 ng/ml (range, -0.2-0.06 ng/ml). In addition, the serum concentration showed minimal intrapatient variability in 20 patients throughout a 1-month period; the average coefficient of variation (standard deviation/mean) in these subjects was 16.5% (range, 6.4-45.2%). These results indicate that the range in the serum concentration of prostate-specific antigen for healthy men with a clinically normal prostate gland is significantly lower (0.0-2.6 ng/ml) than the currently employed range (0.0-4.0 ng/ml; Tandem-R PSA assay); in addition, digital rectal examination and ejaculation have no significant effect on the serum concentration. Finally, the time of day has little effect, and the variability in the serum concentration of prostate-specific antigen over a 1-week and 1-month interval is minimal.

Adult↗

PubMed1988

The effect of digital rectal examination on serum levels of prostatic-specific antigen.

Serum prostate-specific antigen (PSA) and acid phosphatase (AP) levels were measured before and after digital rectal examination in 26 patients with varying genitourinary complaints. Prostate examination had no effect on the level of these markers. However, AP levels demonstrated greater within-day, intraindividual variance than PSA levels. Digital rectal examination does not appear to be a source of preanalytical error for serum PSA or AP determinations.

Acid Phosphatase↗

PubMed1991

Diagnostic yield of a positive fecal occult blood test found on digital rectal examination. Does the finger count?

The value of a positive fecal occult blood test (FOBT) found at the time of digital rectal examination is disputed. To determine the significance of a positive FOBT obtained in this manner, the records of 270 patients who underwent colonoscopy for any positive FOBT were retrospectively reviewed. Occult blood was found in 144 patients at the time of digital rectal examination and in 126 individuals after they submitted three spontaneously passed stool specimens. Of the patients with a positive FOBT on rectal examination, 77% were hospitalized at the time compared with only 17% of those with positive FOBTs from spontaneously passed stools. The frequency of colonic abnormalities was similar with both stool collection methods in inpatients and outpatients. No statistically significant differences in neoplastic polyp or colon cancer detection rates, nor in the finding of hemorrhoids or other anorectal abnormalities, were apparent. Therefore, the belief that a positive FOBT found at the time of digital examination can or should be discounted as a false positive (because of the presence of hemorrhoids or other lesions prone to trauma at the time of digital examination) was not substantiated by this study.

Aged↗

PubMed2000

Use of a prostate model to assist in training for digital rectal examination.

OBJECTIVES: To assess the accuracy of prostate size estimation on digital rectal examination (DRE) before and after training with a three-dimensional prostate model relative to prostate volume by transrectal ultrasound (TRUS). METHODS: A total of 100 subjects underwent DRE by one of four family physicians (FP1, n = 34; FP2, n = 26; FP3, n = 22; and FP4, n = 18). One half were examined before any training on DRE prostate size examination and one half after the physicians were trained. Training involved teaching with a three-dimensional prostate model having posterior surface areas corresponding to the average dimensions of six different prostate volumes. The FPs were instructed to estimate the prostate size on the DRE to the nearest 5 g. A single urologist unaware of the DRE results performed TRUS on all patients to measure the prostate volume. RESULTS: Before training, the DRE size estimates ranged from 10 to 100 g (mean +/- SD 32.8 +/- 21.6), with a TRUS volume of 11 to 122 g (mean +/- SD 38.9 +/- 23.1). The correlation between the DRE and TRUS estimates was 0.25, suggesting low agreement (intraclass correlation coefficient [ICC] 0.35, 95% confidence interval 0.31, 0. 38). After training, 50 different patients had DRE size estimates of 10 to 100 g (mean +/- SD 39.4 +/- 19.7) and TRUS volume of 10 to 119 g (mean +/- SD 41.5 +/- 24.1). The correlation between the techniques was higher in patients examined after training (r = 0. 765), suggesting much better agreement between the techniques (ICC 0. 87; 95% confidence interval 0.86, 0.88). Among the physicians, agreement between DRE and TRUS was higher after training (ICC 0.64 to 0.96) than before training (ICC 0.02 to 0.49). CONCLUSIONS: Although the subjects examined before and after training differed, the agreement between TRUS and DRE prostate size estimates by the FPs appeared to be stronger after training with a three-dimensional prostate model. This model may be a useful tool to assist in training FPs and medical students to measure prostate size on DRE.

Education, Medical↗

PubMed2003

Bimanual digital rectal examination for the evaluation of the nonpalpable testis.

PURPOSE: In the evaluation and treatment of the nonpalpable testis open surgical exploration and laparoscopy are methods used to differentiate abdominal, infrainguinal (below the internal ring) and atrophic or absent testes. We sought to evaluate the use of bimanual digital rectal examination as an additional tool to localize the nonpalpable testis. MATERIALS AND METHODS: Forty-one consecutive patients with 45 nonpalpable testes were evaluated in a prospective fashion. Bimanual digital rectal examination was performed with the patients under general anesthesia just before diagnostic laparoscopy or open inguinal exploration. Palpability, location, length and contralateral testicular length were recorded. RESULTS: Twenty-five gonads or spermatic cords (56%) were palpable using the bimanual technique. All positive examinations were confirmed laparoscopically or by open exploration, and the majority of gonads were intra-abdominal (17 of 25, 68%). Seventeen normal appearing gonads underwent orchiopexy and 8 were removed secondary to atrophy, dysgenesis or poor position. Twenty testes (44%) were not palpated using this method. Of these gonads 10 normal appearing testes were found at exploration and underwent orchiopexy. Of the 10 remaining gonads 6 atrophic testes were removed, and 4 hemosiderin laden remnants were thought to represent "vanished testes." Overall, 26 gonads or remnants were intra-abdominal, 10 were "peeping" or canalicular and 9 were infrainguinal. The overall specificity was 100%, with a sensitivity of 60%. The positive predictive value was 100%. CONCLUSIONS: Bimanual digital rectal examination is a valuable tool in the evaluation of the nonpalpable testis, and identified the presence and position of the testis in the majority of our cases. Although sensitivity is low, when the testis is palpated by this method, diagnostic laparoscopy to localize the testis may be avoided.

Algorithms↗

PubMed2006

The sensitivity and specificity of the digital rectal examination for detecting spinal cord injury in adult patients with blunt trauma.

STUDY OBJECTIVES: The digital rectal examination (DRE) may assist physicians in detecting spinal cord injury in patients with blunt trauma. However, the test characteristics of the DRE for detecting spinal cord injury are unknown. METHODS: We conducted a retrospective review of consecutive adult patients with blunt trauma over a 2-year period. The DRE result was compared with the presence or absence of spinal cord injury at discharge. RESULTS: A total of 1032 adult patients with blunt trauma had a DRE. Of these, 54 (5.2%) had diagnoses consistent with spinal cord injury. Ninety-nine patients had decreased rectal tone, 27 of whom also had spinal cord injuries. The sensitivity, specificity, positive predictive value, and negative predictive values were 50%, 93%, 27%, and 97%, respectively. CONCLUSION: The DRE is insensitive to spinal cord injury and has a poor positive predictive value. The high specificity must be balanced against the large number of false-positive results.

Adult↗

PubMed1991

Preoperative prediction of pathological tumor volume and stage in clinically localized prostate cancer: comparison of digital rectal examination, transrectal ultrasonography and magnetic resonance imaging.

Accurate preoperative staging is important for proper selection of patients for radical retropubic prostatectomy. Preoperative staging by digital rectal examination, transrectal ultrasound, magnetic resonance imaging (MRI), Gleason grade and prostate specific antigen was compared to pathological stage for 25 patients who underwent radical retropubic prostatectomy. The predictive value for tumor confinement was 36% by rectal examination, 37% by ultrasound and 30% by MRI. The predictive value for extracapsular disease was 100% by rectal examination, 83% by ultrasound and 66% by MRI. Preoperative determinations of tumor volume by any modality did not correlate with pathological tumor volume. Digital rectal examination, ultrasound and MRI clinically understage the disease in most patients but they may be reliable to predict extracapsular disease.

Aged↗

PubMed2002

Teaching digital rectal examinations to medical students: an evaluation study of teaching methods.

PURPOSE: The digital rectal examination (DRE) is a necessary part of a complete physical examination and evaluation of a patient, yet teaching of this examination to medical students is often inadequate. This study was a comparative evaluation of the effectiveness of the rectal teaching associate (RTA), lecture, role-playing, and simulated models as methods for teaching the DRE procedure to undergraduate medical students at Memorial University of Newfoundland Faculty of Medicine. METHOD: A total of 65 third-year medical students were randomly assigned to either an experimental or control group. Both groups received a lecture and practiced the DRE on a simulated model. The experimental group received further training from an RTA. Students completed a pre- and post-intervention knowledge assessment, an objective structured clinical exam (OSCE) measuring performance of the DRE, and a satisfaction survey. RESULTS: Mean knowledge scores increased significantly for both groups (18.73 to 22.32, p <.0001). The control group scored significantly higher on the post-intervention assessment than did the experimental group (23.11 versus 21.47, p =.025) The experimental group scored higher on the OSCE (27.52 versus 23.80, p =.001) and rated the RTA as a more effective method for learning the DRE. CONCLUSIONS: This first study using RTAs to teach the DRE as a global skill for evaluating the rectum suggests that the RTA method is effective for increasing skills and students' confidence in the procedure.

Curriculum↗

PubMed1994

[Usefulness and limitation of digital rectal examination and imaging studies in staging prostate cancer].

The diagnostic usefulness of digital rectal examination (DRE), transrectal ultrasonography (TRUS), magnetic resonance imaging (MRI) and computed tomography (CT) was compared in the differentiation of stage B from stage C prostate cancer. Eighteen patients who had undergone radical retropubic prostatectomy were included in this study. Overall, the positive predictive values (PPV) for detecting extraprostatic disease (extracapsular extension, seminal vesicle invasion) were 100% for DRE, 88.9% for TRUS and 80.0% for MRI, respectively. Corresponding figures for accuracy in detecting extraprostatic spread were 55.6%, 66.7% and 61.1%, respectively. The PPV and accuracy for detecting extraprostatic disease in 13 patients with localized cancer (< stage B) were 75.0%, 53.8% for TRUS and 66.7%, 53.8% for MRI, respectively. Both of these examinations appeared to be superior to DRE alone. The PPV and accuracy increased when findings on TRUS and MRI coincided. Computed tomography was less accurate than MRI in diagnosing nodal involvement because of the higher incidence of false positives. Further efforts should be focused on enhancing preoperative diagnostic precision in staging prostate cancer because of the limited usefulness of the current imaging techniques. Development of more reliable diagnostic modalities or designing ideal combination of these studies are desperately needed.

Aged↗