An abnormal digital rectal examination is an independent predictor of Gleason > or =7 prostate cancer in men undergoing initial prostate biopsy: a prospective study of 790 men.
OBJECTIVE
To evaluate our experience with a referral population of 790 patients undergoing initial prostate biopsy in the prostate-specific antigen (PSA) era, to assess the role of a digital rectal examination (DRE) in predicting the outcome of prostate needle biopsy (PNB) and to evaluate if DRE findings were associated with cancer grade.


METHODS
We analysed 790 consecutive men who had an initial PNB from September 1999 to July 2005 by one urologist (C.P.). All data were collected in a prospective database. Multivariate logistic regression analysis was used to determine the relationship between an abnormal DRE and the presence of cancer and cancer grade on PNB.


RESULTS
An abnormal DRE was an independent predictor for prostate cancer on multivariate analysis (odds ratio 2.18, 95% confidence interval 1.53-3.10, P < 0.001). In all patients biopsied, an abnormal DRE was associated with a Gleason sum of > or = 7 on multivariate analysis (odds ratio 3.39, 2.07-5.53, P = 0.001).


CONCLUSIONS
A DRE is a useful and important tool to use when assessing patients for a PNB. An abnormal DRE independently predicted high-grade disease in these men. These results might have important implications in the prediction of men with other than indolent prostate cancer.
Borden
Lester S
LS
Department of Urology, Virginia Mason Medical Center, University of Washington, 1100 9th Avenue, Seattle, WA 98101, USA.
Wright
Jonathan L
JL
Kim
Jason
J
Latchamsetty
Kalyan
K
Porter
Christopher R
CR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000592:standards; D051517:Digital Rectal Examination / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis*
D017430:Prostate-Specific Antigen