Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men
1994; Lippincott Williams & Wilkins; Volume: 151; Issue: 5 Linguagem: Inglês
10.1016/s0022-5347(17)35233-3
ISSN1527-3792
AutoresWilliam J. Catàlona, Jerome P. Richie, Frederick R. Ahmann, M’Liss A. Hudson, Peter T. Scardino, Robert C. Flanigan, Jean B. deKernion, Timothy L. Ratliff, Louis R. Kavoussi, Bruce L. Dalkin, W. Bedford Waters, Michael T. Macfarlane, Paula C. Southwick,
Tópico(s)Prostate Cancer Treatment and Research
ResumoNo AccessJournal of Urology1 May 1994Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men William J. Catalona, Jerome P. Richie, Frederick R. Ahmann, M’Liss A. Hudson, Peter T. Scardino, Robert C. Flanigan, Jean B. Dekernion, Timothy L. Ratliff, Louis R. Kavoussi, Bruce L. Dalkin, W. Bedford Waters, Michael T. Macfarlane, and Paula C. Southwick William J. CatalonaWilliam J. Catalona More articles by this author , Jerome P. RichieJerome P. Richie More articles by this author , Frederick R. AhmannFrederick R. Ahmann More articles by this author , M’Liss A. HudsonM’Liss A. Hudson More articles by this author , Peter T. ScardinoPeter T. Scardino More articles by this author , Robert C. FlaniganRobert C. Flanigan More articles by this author , Jean B. DekernionJean B. Dekernion More articles by this author , Timothy L. RatliffTimothy L. Ratliff More articles by this author , Louis R. KavoussiLouis R. Kavoussi More articles by this author , Bruce L. DalkinBruce L. Dalkin More articles by this author , W. Bedford WatersW. Bedford Waters More articles by this author , Michael T. MacfarlaneMichael T. Macfarlane More articles by this author , and Paula C. SouthwickPaula C. Southwick More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)35233-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail To compare the efficacy of digital rectal examination and serum prostate specific antigen (PSA) in the early detection of prostate cancer, we conducted a prospective clinical trial at 6 university centers of 6,630 male volunteers 50 years old or older who underwent PSA determination (Hybritech Tandom-E or Tandem-R assays) and digital rectal examination. Quadrant biopsies were performed if the PSA level was greater than 4 μg./l or digital rectal examination was suspicious, even if transrectal ultrasonography revealed no areas suspicious for cancer. The results showed that 15% of the men had a PSA level of greater than 4 μg./l, 15% had a suspicious digital rectal examination and 26% had suspicious findings on either or both tests. Of 1,167 biopsies performed cancer was detected in 264. PSA detected significantly more tumors (82%, 216 of 264 cancers) than digital rectal examination (55%, 146 of 264, p = 0.001). The cancer detection rate was 3.2% for digital rectal examination, 4.6% for PSA and 5.8% for the 2 methods combined. Positive predictive value was 32% for PSA and 21% for digital rectal examination. Of 160 patients who underwent radical prostatectomy and pathological staging 114 (71%) had organ confined cancer: PSA detected 85 (75%) and digital rectal examination detected 64 (56%, p = 0.003). Use of the 2 methods in combination increased detection of organ confined disease by 78% (50 of 64 cases) over digital rectal examination alone. If the performance of a biopsy would have required suspicious transrectal ultrasonography findings, nearly 40% of the tumors would have been missed. We conclude that the use of PSA in conjunction with digital rectal examination enhances early prostate cancer detection. Prostatic biopsy should be considered if either the PSA level is greater than 4μg./l. or digital rectal examination is suspicious for cancer, even in the absence of abnormal transrectal ultrasonography findings. © 1994 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHalpern J, Oromendia C, Shoag J, Mittal S, Cosiano M, Ballman K, Vickers A and Hu J (2018) Use of Digital Rectal Examination as an Adjunct to Prostate Specific Antigen in the Detection of Clinically Significant Prostate CancerJournal of Urology, VOL. 199, NO. 4, (947-953), Online publication date: 1-Apr-2018.Halpern J, Shoag J, Mittal S, Oromendia C, Ballman K, Hershman D, Wright J, Shih Y, Nguyen P and Hu J (2018) Prognostic Significance of Digital Rectal Examination and Prostate Specific Antigen in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening ArmJournal of Urology, VOL. 197, NO. 2, (363-368), Online publication date: 1-Feb-2017.Kim E, Andriole 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Volume 151Issue 5May 1994Page: 1283-1290 Advertisement Copyright & Permissions© 1994 by The American Urological Association Education and Research, Inc.Keywordsultrasonographydiagnosisneoplasmantigensprostatic neoplasmsMetricsAuthor Information William J. Catalona More articles by this author Jerome P. Richie More articles by this author Frederick R. Ahmann More articles by this author M’Liss A. Hudson More articles by this author Peter T. Scardino More articles by this author Robert C. Flanigan More articles by this author Jean B. Dekernion More articles by this author Timothy L. Ratliff More articles by this author Louis R. Kavoussi More articles by this author Bruce L. Dalkin More articles by this author W. Bedford Waters More articles by this author Michael T. Macfarlane More articles by this author Paula C. Southwick More articles by this author Expand All Advertisement PDF downloadLoading ...
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