[Validity of digital rectal examination in the era of prostate specific antigen].
OBJECTIVE
To determine the presence of a possible correlation between prostate specific antigen (PSA) and the findings from digital rectal examination (DRE) in patients with prostate cancer or benign prostatic hyperplasia.


METHODS
Retrospective, longitudinal, and observational study of diagnostic tests.


METHODS
Gregorio Marañón Hospital, Madrid, Spain.


METHODS
It included 706 patients with a PSA in the range 4.1-20 ng/mL, studied owing to suspected prostate cancer localised using DRE and transrectal ultrasound, in whom randomised prostate biopsies were performed.


METHODS
Total PSA and free/total PSA ratio and DRE normal or suspicious were studied as main variables. The outcome variable was the diagnosis of prostatic cancer by biopsy.


RESULTS
With a detection of cancer of 28.2%, there were no statistically significant differences in the PSA or free/total PSA ratio mean values between patients with or without suspicious DRE. The analysis using ROC curves (with a 95% confidence interval) between both groups of patients found the same sensitivity of 95% with a similar specificity of 6% and 10%, respectively, for a PSA of 4.8 ng/mL.


CONCLUSIONS
In the PSA range of 4.1-20 ng/mL, the findings of DRE appeared as a variable unrelated to the increase in PSA or the free/total PSA ratio and, therefore are not indicative of a lesser or greater volume of a tumour producing PSA. The performing of this examination could be considered as optional.
Alonso-Sandoica
E
E
Centro de Salud García Noblejas, Madrid, Spain. jjara@teleline.es
Jara-Rascón
J
J
Martínez-Salamanca
J I
JI
Hernández-Fernández
C
C
D000328:Adult; D051517:Digital Rectal Examination / Q000592:standards*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000097:blood* / Q000175:diagnosis*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies
D017430:Prostate-Specific Antigen