Digital Rectal Examination (DRE)

[greenddog1]

I've been on an alpha blocker for about 10 years and 2 years ago added Avodart (Dutasteride). All worked but, within the last 3-4 months the problems worsened,
even when increasing my 5mg dose to 2x day. Have had the biopsy about 5 years ago and have another scheduled Wednesday to see what's going on. I'm posting a link of a pdf that some may find interesting. If nothing else,it confirmed my original decision to go with dutasteride over Proscar (Finestaride).
http://www.oregon.gov/OHA/.../therapeutics/docs/ps-2010-03-bph.pdf

 

[LW64]

At just 21 posts, this may be the most informative thread I've seen in a long time!

: - )

 

[toolman]

At just 21 posts, this may be the most informative thread I've seen in a long time!

: - )

Agreed...like the good old days!

Daily Cialis took care of my BPH symptoms immediately. It is also great to be able to get a hard on at will.

 

[Michael Scally MD]

Digital Rectal Examination Remains a Key Prognostic Tool for Prostate Cancer

BACKGROUND: Prostate cancer clinical stage T2 (cT2) subclassifications, as determined by digital rectal examination (DRE), are a historic method of staging prostate cancer. However, given the potential discomfort associated with prostate examination and the wide availability of other prognostic tests, the necessity of DRE is uncertain. This study sought to determine the prognostic value of the prostate cancer cT2 subclassifications in a contemporary cohort of patients.

METHODS: The National Cancer Database was used to identify a cohort of men with high-risk clinical T2N0M0 prostate cancer treated with external-beam radiotherapy and androgen deprivation therapies +/- surgery from 2004 to 2010. We assessed overall survival from a landmark time of 10 months using Kaplan-Meier and log-rank test analysis.

A multivariate proportional hazards model was used to estimate the simultaneous effects of multiple factors, including cT2 subclassification and other well-established prognostic indicators of overall survival in prostate cancer.

RESULTS: A total of 5,291 men were included in the final analysis, with a median follow-up of 5.4 years. The cT2a, cT2b, and cT2c subclassifications demonstrated increasing hazard ratios of 1.00 (reference), 1.25 (95% CI, 1.07-1.45; P=.0046), and 1.43 (95% CI, 1.25-1.63; P<.0001), respectively, reflecting a higher probability of death with each incremental increase in cT2 subclassification. This finding was independent of other known prognostic variables on multivariate analysis.

CONCLUSIONS: Results show that cT2 subclassifications had independent prognostic value in a large and contemporary cohort of men. cT2 classification remains an important, low-cost prognostic tool for men with prostatic adenocarcinoma. The clinical relevance of this test should be appreciated and accounted for by providers treating prostate adenocarcinoma.

Borkenhagen JF, Eastwood D, Kilari D, et al. Digital Rectal Examination Remains a Key Prognostic Tool for Prostate Cancer: A National Cancer Database Review. Journal of the National Comprehensive Cancer Network : JNCCN 2019;17:829-37. Digital Rectal Examination Remains a Key Prognostic Tool for Prostate Cancer: A National Cancer Database Review in: Journal of the National Comprehensive Cancer Network Volume 17 Issue 7 (2019)

 

[Michael Scally MD]

[OA] Digital Rectal Examination for Prostate Cancer Screening in Primary Care

PURPOSE - Although the digital rectal examination (DRE) is commonly performed to screen for prostate cancer, there is limited data to support its use in primary care. This review and meta-analysis aims to evaluate the diagnostic accuracy of DRE in screening for prostate cancer in primary care settings.

METHODS - We searched MEDLINE, Embase, DARE (Database of Abstracts of Reviews of Effects), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from their inception to June 2016. Six reviewers, in pairs, independently screened citations for eligibility and extracted data.

Pooled estimates were calculated for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DRE in primary care settings using an inverse-variance meta-analysis. We used QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) and GRADE (Grades of Recommendation Assessment, Development, and Evaluation) guidelines to assess study risk of bias and quality.

RESULTS - Our search yielded 8,217 studies, of which 7 studies with 9,241 patients were included after the screening process. All patients analyzed underwent both DRE and biopsy. Pooled sensitivity of DRE performed by primary care clinicians was 0.51 (95% CI, 0.36–0.67; I2 = 98.4%) and pooled specificity was 0.59 (95% CI, 0.41–0.76; I2 = 99.4%). Pooled PPV was 0.41 (95% CI, 0.31–0.52; I2 = 97.2%), and pooled NPV was 0.64 (95% CI, 0.58–0.70; I2 = 95.0%). The quality of evidence as assessed with GRADE was very low.

CONCLUSION - Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.

Naji L, Randhawa H, Sohani Z, et al. Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis. Ann Fam Med. 2018;16(2):149–154. Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis

 

[GDL]

Exactly what my doctor said. He told me to pay attention and I’ll notice if something changes. And if it does to get it checked out and not assume it’s normal from now on.

 

[Michael Scally MD]