title: The digital rectal examination (DRE) remains important - outcomes from a contemporary cohort of men undergoing an initial 12-18 core prostate needle biopsy.
abstract: BACKGROUND
  Indications for prostate needle biopsy (PNB) include elevated serum prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE).  We evaluated a contemporary cohort of men undergoing PNB to determine cancer detection rates when stratified by DRE status.
  
  
  METHODS
  The charts of 806 men who underwent a PNB were reviewed.  Serum PSA was categorized as normal or abnormal according to age-specific criteria.  A normal DRE was defined as a smooth, age-appropriate, asymmetric, or uniformly enlarged prostate.  An abnormal DRE was defined by either a nodule or induration.  Sensitivity, specificity, and predictive values were determined for an abnormal DRE and the diagnosis of prostate cancer.
  
  
  RESULTS
  Within the cohort, 516 patients (64%) had a normal and 290 (36%) an abnormal DRE.  Three hundred six (38%) men were diagnosed with prostate cancer of which 136 (44%) had an abnormal DRE.  Fourteen percent of patients with prostate cancer had an isolated DRE abnormality.  Furthermore, when specifically considering these 136 men with an abnormal DRE and prostate cancer, 43 (31%) had a normal age-specific PSA value.  No differences in cancer detection rate were noted when stratifying by type of DRE abnormality.  In this select cohort of patients undergoing prostate biopsy, an abnormal DRE had a sensitivity of 44%, specificity of 68%, positive predictive value (PPV) of 46%, and a negative predictive value (NPV) of 67% for detecting prostate cancer on biopsy.
  
  
  CONCLUSIONS
  Almost 50% of men in our cohort diagnosed with prostate cancer had an abnormal DRE.  While only 14% of all patients with prostate cancer had an isolated DRE abnormality, 31% of these men had normal age-specific PSA values.  Such observations underscore the importance of the DRE for prostate cancer screening.
authors.affiliation: Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Palmerola
authors.forename: Paul
authors.initials: P
authors.lastname: Smith
authors.forename: Vanessa
authors.initials: V
authors.lastname: Elliot
authors.forename: Carl T
authors.initials: CT
authors.lastname: Reese
authors.forename: Frank B
authors.initials: FB
authors.lastname: Mahon
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Harpster
authors.forename: Nikolina
authors.initials: N
authors.lastname: Icitovic
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000379:methods; D015331:Cohort Studies; D051517:Digital Rectal Examination / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D017430:Prostate-Specific Antigen