Predictive value of digital rectal examination for prostate cancer detection is modified by obesity.
Predictive value of digital rectal examination for prostate cancer detection is modified by obesity.
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DOI：
10.1038/pcan.2011.31
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发表时间：
2011-12
影响因子：
4.8
通讯作者：
Bañez LL
中科院分区：
文献类型：
--
作者：
Chu DI;De Nunzio C;Gerber L;Thomas JA 2nd;Calloway EE;Albisinni S;Senocak C;McKeever MG;Moreira DM;Tubaro A;Moul JW;Freedland SJ;Bañez LL
美国癌症协会（American Cancer Society）更新的前列腺癌筛查指南（CaP）使直肠指检（DRE）成为可选项。我们调查了DRE对肥胖男性CaP检测的影响。分析了三个中心2794名接受初始前列腺活检的男性的数据，以评估不同身体质量指数（BMI）类别中DRE异常导致的CaP风险。结合PSA、年龄、种族、中心和活检年份（包括或不包括DRE发现）的预测准确性通过接受者操作特征曲线（AUC）下的面积进行比较。在所有队列中，肥胖男性诊断出异常DREs的可能性低于非肥胖男性。随着BMI类别的增加，异常DREs成为个体（p-trends≤0.05）和联合（p-trend<0.001）队列总体CaP以及意大利（p-trend=0.03）和联合（p-trend=0.03）队列高级CaP的较强预测因子。DRE纳入提高了所有肥胖男性总体和高级CaP检测的预测准确性（p≤0.032），但没有提高正常体重男性的预测准确性（p≥0.198）。在PSA<4ng/mL的肥胖男性中，纳入DRE也几乎显著提高了CaP的总体检测（p=0.081）。综上所述，DRE的预测价值依赖于肥胖，肥胖男性的预测价值明显高于正常体重男性。
The American Cancer Society’s updated screening guidelines for prostate cancer (CaP) render digital rectal examination (DRE) optional. We investigated the impact of DRE on CaP detection among obese men. Data from 2794 men undergoing initial prostate biopsy at three centers were analyzed to assess CaP risk attributed to abnormal DRE across body-mass index (BMI) categories. Predictive accuracies of a combination of PSA, age, race, center, and biopsy year including or excluding DRE findings were compared by areas under the receiver-operating characteristics curves (AUC). In all cohorts, obese men were less likely to have abnormal DREs diagnosed than non-obese men. As BMI category increased, abnormal DREs became stronger predictors for overall CaP in individual (p-trends≤0.05) and combined (p-trend<0.001) cohorts, and for high-grade CaP in the Italian (p-trend=0.03) and combined (p-trend=0.03) cohorts. DRE inclusion improved the predictive accuracy for overall and high-grade CaP detection among all obese men (p≤0.032) but not normal-weight men (p≥0.198). DRE inclusion also near-significantly improved overall CaP detection in obese men with PSA<4ng/mL (p=0.081). In conclusion, the predictive value of DRE is dependent on obesity and is significantly higher among obese men than normal-weight men.