title: Prognostic Significance of Digital Rectal Examination and Prostate Specific Antigen in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Arm.
abstract: The absence of definitive data or explicit guidelines regarding the use of digital rectal examination for prostate cancer screening may lead to confusion for physicians and patients alike. We evaluated the prognostic value of abnormal digital rectal examination and prostate specific antigen following the widespread dissemination of prostate specific antigen testing in the U.S.
  
  
  
  Collectively, men comprising the screening arm of the PLCO cancer screening trial who underwent digital rectal examination screening (35,350) were followed for 314,033 person-years. Adjusted analyses with competing risks regression were performed to assess the association of suspicious (nodularity, induration, asymmetry) digital rectal examination and abnormal prostate specific antigen (4 ng/ml or greater) with the detection of clinically significant prostate cancer, prostate cancer specific mortality and overall mortality.
  
  
  
  Among all screening encounters with a suspicious digital rectal examination only 15.4% had a concurrently abnormal prostate specific antigen (McNemar's test p <0.001). During followup there were 1,612 clinically significant prostate cancers detected, 64 prostate cancer specific deaths and 4,600 deaths. On multivariable analysis suspicious digital rectal examination and abnormal prostate specific antigen were associated with a greater risk of clinically significant prostate cancer (HR 2.21, 95% CI 1.99-2.44 vs HR 5.48, 95% CI 5.05-5.96, p <0.001 and p <0.001) and prostate cancer specific mortality (HR 2.54, 95% CI 1.41-4.58 vs HR 5.23, 95% CI 3.08-8.88, p=0.002 and p <0.001), respectively.
  
  
  
  In a secondary analysis of a contemporary U.S. cohort, suspicious digital rectal examination and abnormal prostate specific antigen on routine screening were independently associated with clinically significant prostate cancer and prostate cancer specific mortality. However, additional research is needed to optimize screening protocols.
authors: Department of Urology, New York Presbyterian/Weill Cornell Medicine, New York, New York.
authors: Joshua A
authors: JA
authors: Halpern
authors: Department of Urology, New York Presbyterian/Weill Cornell Medicine, New York, New York.
authors: Jonathan E
authors: JE
authors: Shoag
authors: Department of Urology, New York Presbyterian/Weill Cornell Medicine, New York, New York.
authors: Sameer
authors: S
authors: Mittal
authors: Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York.
authors: Clara
authors: C
authors: Oromendia
authors: Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York.
authors: Karla V
authors: KV
authors: Ballman
authors: Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York.
authors: Dawn L
authors: DL
authors: Hershman
authors: Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York.
authors: Jason D
authors: JD
authors: Wright
authors: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Ya-Chen Tina
authors: YT
authors: Shih
authors: Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
authors: Paul L
authors: PL
authors: Nguyen
authors: Department of Urology, New York Presbyterian/Weill Cornell Medicine, New York, New York. Electronic address: jch9011@med.cornell.edu.
authors: Jim C
authors: JC
authors: Hu
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis; D051517:Digital Rectal Examination / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D015996:Survival Rate; D014481:United States
chemical_list: D017430:Prostate-Specific Antigen
keywords: digital rectal examination; early detection of cancer; prostate-specific antigen; prostatic neoplasms