Value of digital rectal examination in patients with suspected prostate cancer: a prospective cohort analysis study.
Value of digital rectal examination in patients with suspected prostate cancer: a prospective cohort analysis study.
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DOI：
10.21037/tau-23-371
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发表时间：
2023-11-30
影响因子：
2
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直肠指检（DRE）是一种简单、经济、实用和历史悠久的体检方法，在前列腺癌（PCa）的检测中发挥着重要作用。然而，随着前列腺特异性抗原（PSA）时代的到来，进行DRE的必要性已成为争论的主题。我们的目的是研究DRE在疑似PCa人群（前列腺成像报告和数据系统（PI-RADS），PI-RADS ≥3或PSA ≥4 ng/mL）中的诊断有效性和预防作用。从2020年2月至2021年5月连续前瞻性入组了597例需要转诊活检的疑似PCa患者。所有患者在活检前均接受DRE和泌尿科医生的相应临床诊断。根据收集的临床和病理资料，统计分析DRE在不同PSA分层中的诊断性能，以及与肿瘤部位和Gleason评分（GS）的关系。在可疑癌症患者中，DRE的诊断准确率为63.45%。与中央区或移行区肿瘤相比，周围区肿瘤的DREs阳性结果的召回率更高（65.50% vs. 34.55%）。DRE阳性与GS ≥7的PCa显著相关（P<0.001），DRE阳性的PCa患者GS平均值显著高于DRE阴性者（7.92vs.7.11，P<0.001）。DRE可帮助医生进一步判断PSA升高患者活检的必要性，并初步估计肿瘤的位置和侵袭性。然而，仍有必要探讨DRE在正常PSA人群中的价值。
Digital rectal examination (DRE) is a straightforward, cost-effective, practical, and time-honored physical examination method that plays a valuable role in the detection of prostate cancer (PCa). Nevertheless, with the advent of the prostate-specific antigen (PSA) era, the necessity of performing DRE has become a subject of debate. Our aim was to investigate the diagnostic efficacy and adjunctive role of DRE in a population (Prostate Imaging Reporting and Data System (PI-RADS), PI-RADS ≥3 or PSA ≥4 ng/mL) suspected of PCa. Five hundred and ninety-seven patients with suspected PCa requiring referral for biopsy were prospectively enrolled consecutively from February 2020 to May 2021. All patients received DRE and corresponding clinical diagnosis by a urologist before biopsy. According to the collected clinical and pathological information, the diagnostic performance of DRE in different PSA stratifications, and its association with tumor location and Gleason score (GS) were statistically analyzed. Among patients with suspected cancer, the diagnostic accuracy of DRE was 63.45%. Compared with central zone or transition zone tumors, the recall rate of peripheral zone PCa with DRE-positive results was higher (65.50% vs. 34.55%). DRE-positive results were significantly correlated with GS ≥7 PCa (P<0.001), and the average GS of DRE-positive PCa patients was significantly higher than that of DRE-negative (7.92 vs. 7.11, P<0.001). DRE may help physicians further judge the necessity of biopsy in patients with elevated PSA, and preliminarily estimate the location and invasiveness of the tumor. However, it is still necessary to explore the value of DRE in a normal PSA population.