Clinical diagnosis of prostate cancer using digital rectal examination and prostate-specific antigen tests: a systematic review and meta-analysis of sensitivity and specificity

Abstract Background Being diagnosed with cancer, irrespective of type initiates a serious psychological concern. The increasing rate of detection of indolent prostate cancers is a source of worry to public health. Digital rectal examination and prostate-specific antigen tests are the commonly used prostate cancer screening tests. Understanding the diagnostic accuracies of these tests may provide clearer pictures of their characteristics and values in prostate cancer diagnosis. This review compared the sensitivities and specificities of digital rectal examination and prostate-specific antigen test in detection of clinically important prostate cancers using studies from wider population. Main body We conducted literature search in PubMed, Medline, Science Direct, Wiley Online, CINAHL, Scopus, AJOL and Google Scholar, using key words and Boolean operators. Studies comparing the sensitivity and specificity of digital rectal examination and prostate-specific antigen tests in men 40 years and above, using biopsy as reference standard were retrieved. Data were extracted and analysed using Review manager (RevMan 5.3) statistical software. The overall quality of the studies was good, and heterogeneity was observed across the studies. The result comparatively shows that prostate-specific antigen test has higher sensitivity (P < 0.00001, RR 0.74, CI 0.67–0.83) and specificity (P < 0.00001, RR 1.81, CI 1.54–2.12) in the detection of prostate cancers than digital rectal examination. Conclusion Prostate-specific antigen test has higher sensitivity and specificity in detecting prostate cancers from men of multiple ethnic origins. However, combination of prostate-specific antigen test and standardized digital rectal examination procedure, along with patients history, may improve the accuracy and minimize over-diagnoses of indolent prostate cancers.

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Occupation as a predictor of prostate cancer screening behaviour in Canada

Journal of Medical Screening ◽

10.1177/0969141320902485 ◽

2020 ◽

Vol 27 (4) ◽

pp. 215-222

Author(s):

Cheryl E Peters ◽

Paul J Villeneuve ◽

Marie-Élise Parent

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Prostate Specific Antigen ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Antigen Test ◽

Screening Practices ◽

Rectal Examination ◽

Prostate Specific Antigen Test

Objectives If prostate cancer screening practices relate to occupation, this would have important implications when studying the aetiological role of workplace exposures on prostate cancer. We identified variations in screening by occupation among men in Montreal, Canada (2005–2012). Methods Prostate specific antigen testing and digital rectal examination (ever-screened and frequency of screening, previous five years) were examined among population controls from the Prostate Cancer & Environment Study. Face-to-face interviews elicited lifestyle and occupational histories. Multivariable logistic regression was used to estimate the odds of ever-screening for the longest-held occupation, adjusting for potential confounders. Negative binomial models were used to examine relationships with screening frequency. Results Among 1989 controls, 81% reported ever having had a prostate specific antigen test, and 77% a digital rectal examination. Approximately 40% of men reported having a prostate specific antigen test once a year, on average. Compared with those in management or administrative jobs, men in primary industry (odds ratio 0.26, 95% confidence interval 0.10–0.65), construction (0.44, 0.25–0.79), machining (0.45, 0.21–0.97), and teaching (0.37, 0.20–0.70) were less likely to have undergone prostate specific antigen screening. Results were similar when considering the most recent job. Conclusions Our findings highlight substantial variations in prostate cancer screening by occupation. Men in occupations where carcinogen exposures are more common are less likely to participate in prostate screening activities. This could be an important source of bias, and occupational studies of prostate cancer should account for screening practices.

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Screening by Prostate-Specific Antigen and Digital Rectal Examination in Relation to Prostate Cancer Mortality. A Case-Control Study

The Journal of Urology ◽

10.1016/s0022-5347(01)68791-3 ◽

2005 ◽

Vol 174 (5) ◽

pp. 1824-1825 ◽

Cited By ~ 1

Author(s):

Patrick C. Walsh

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Cancer Mortality ◽

Case Control Study ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Case Control ◽

Rectal Examination ◽

Prostate Cancer Mortality ◽

Control Study

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ROLE OF PROSTATE-SPECIFIC ANTIGEN AND DIGITAL RECTAL EXAMINATION IN THE DETECTION OF PROSTATE CANCER

International Journal of Urology ◽

10.1111/j.1442-2042.1994.tb00013.x ◽

1994 ◽

Vol 1 (1) ◽

pp. 74-77 ◽

Cited By ~ 2

Author(s):

Masanori Yamamoto ◽

Hatsuki Hibi ◽

Koji Miyake

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Rectal Examination

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Comparing Two Modalities of Screening for Prostate Cancer: Digital Rectal Examination + Transrectal Ultrasonography Vs. Prostate-Specific Antigen

Tumori Journal ◽

10.1177/030089169508100401 ◽

1995 ◽

Vol 81 (4) ◽

pp. 225-229 ◽

Cited By ~ 19

Author(s):

Stefano Ciatto ◽

Rita Bonardi ◽

Antonia Mazzotta ◽

Claudio Lombardi ◽

Roberto Santoni ◽

...

Keyword(s):

Prostate Cancer ◽

Early Detection ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Transrectal Ultrasonography ◽

Attendance Rate ◽

Predictive Values ◽

Rectal Examination ◽

Biopsy Rate

Aims and background To evaluate the performance and feasibility of screening for prostate cancer by comparing screening modalities. Methods Prospective study of two comparable cohorts of healthy resident males aged 60 to 75 years. Screening attenders in the two invited cohorts were screened either by digital rectal examination (DRE) and transrectal ultrasonography (TRUS), or by serum prostate-specific antigen determination (PSA: cutoff 4 ng/ml). Attendance and biopsy rates, predictive values, prevalence of screen-detected cancers, as well as screening costs were determined, and the efficiency of the two screening modalities was compared. Results 1425 subjects were screened by DRE + TRUS. Attendance rate was 33.7%, the biopsy rate was 2.7%, and the prevalence of detected cancers was 1.82%. A total of 1315 subjects was screened by PSA. Attendance rate was 66.9%, the biopsy rate was 2.8%, and the prevalence of detected cancers was 1.67%. Screen-detected cancer stage was more favorable than observed in clinical practice, and early detection was evident, with the prevalence/incidence ratio higher than 10:1 in both programs. The cost per subject screened was about 34,000 Lire for DRE + TRSU and about 30,000 Lire for PSA program. Conclusions The study confirms that early detection of prostate cancer is possible and that screening is practically feasible. Both screening modalities achieved comparable results as regards early detection, but screening by PSA had a higher compliance and lower costs. PSA seems the ideal test to be used in prospective controlled studies aimed at demonstrating screening efficacy.

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A nomogram based on age, prostate-specific antigen level, prostate volume and digital rectal examination for predicting risk of prostate cancer

Asian Journal of Andrology ◽

10.1038/aja.2012.111 ◽

2012 ◽

Vol 15 (1) ◽

pp. 129-133 ◽

Cited By ~ 16

Author(s):

Ping Tang ◽

Hui Chen ◽

Matthew Uhlman ◽

Yu-Rong Lin ◽

Xiang-Rong Deng ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Prostate Volume ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Prostate Specific Antigen Level ◽

Antigen Level ◽

Rectal Examination

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Relationship of Prostate Specific Antigen and Digital Rectal Examination in the Prediction of Prostate Cancer

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v16i2.29122 ◽

2020 ◽

Vol 16 (2) ◽

pp. 83-87

Author(s):

Bhusan Raj Timilsina ◽

Gaurav Devkota ◽

Shweta Giri ◽

Sulav Pradhan ◽

Sudeep RaJ KC

Keyword(s):

Prostate Cancer ◽

Diagnostic Accuracy ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Cross Sectional Study ◽

Medical Sciences ◽

Cross Sectional ◽

Rectal Examination ◽

Relationship Of

Background: Prostate cancer is one of the most common and leading cause of death among different genitourinary causes. However, screening of prostate cancer is limited to Digital Rectal Examination (DRE) and Prostate Specific Antigen (PSA) in Nepal. The aim of this study is to find out which modality is more helpful for the diagnosis of Prostate Cancer. Methods: A retrospective cross-sectional study was conducted in the department of Urology, College of Medical Sciences, Chitwan, Nepal. All patients included in this study were who presented to the OPD with Lower Urinary Tract Symptoms (LUTS). The patients were above the age of 40 with clinical suspicion prostate cancer based on either DRE or PSA. Results: A total of 150 patients were enrolled from April 2019 to April 2020. Their mean± SD age was of 65.18±9.38 years. The accuracy of the diagnostic test for DRE and PSA were cut off at 4, PSA cut off range of 4 to 10, PSA cut off range of 10 to 30 and PSA cut off at 30 showed that all the screening indices were better for DRE (Sensitivity=100%, Specificity=59.2%, Diagnostic Accuracy=62.2%) than for PSA cut off at 4 (Sensitivity=100%, Specificity=27.6%, Diagnostic Accuracy=32.9%). Among various cut off score or ranges for PSA, cut off score at 30 provided the best screening indices with Sensitivity of 66.7%, Specificity of 97.4% and Diagnostic Accuracy of 95.1%. Conclusions: PSA has higher diagnostic accuracy then DRE. Keywords: DRE; LUTS; Prostate cancer; PSA.

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Prostate Cancer Education, Detection, and Follow-Up in a Community-Based Multiethnic Cohort of Medically Underserved Men

American Journal of Men s Health ◽

10.1177/1557988315584794 ◽

2016 ◽

Vol 11 (1) ◽

pp. 82-91 ◽

Cited By ~ 5

Author(s):

Omotola S. Ashorobi ◽

Jacqueline Frost ◽

Xuemei Wang ◽

Pamela Roberson ◽

E. Lin ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Cancer Education ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Medically Underserved ◽

Underserved Communities ◽

Rectal Examination ◽

Multiethnic Cohort

The Prostate Outreach Project (POP) provided free prostate cancer (PCa) education and early detection to medically underserved communities. POP recruited participants in medically underserved communities. PCa education and detection events occurred in POP locations (static) or natural gathering places (mobile) within the community. PCa education was delivered by video and evaluated using a questionnaire. Screening consisted of serum prostate-specific antigen and digital rectal examination. A navigated follow-up strategy was utilized to provide medical care for participants with abnormal screening examinations (ASE). POP recruited 4,420 men, 62.8% (2,667) were African American (AA). Most participants had a high school education and no prior screening. Fifty-four percent (2,159) were uninsured and 41% (1,811) had no access to a physician. PCa knowledge increased following the educational video. Prostate-specific antigen levels were elevated in 9.8% (436), while 6.9% (233) had an abnormal digital rectal examination. Follow-up among 609 men with ASE was successful in 40% (244), despite a navigated approach. Overall, 3.3% (144) cancers were diagnosed among the POP with AA participants exhibiting a significantly higher incidence. Recruitment, education, and PCa testing among a medically underserved cohort was successful. However, failure to follow through on ASE could contribute to maintaining the disparity in PCa outcomes noted among AAs and the medically underserved if not addressed.

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