Ten-Year Trends in Digital Rectal Exam Results and Prostate Cancer Detection: Insights from the PLCO Trial.

IF 2.7 Q2 UROLOGY & NEPHROLOGY
Research and Reports in Urology Pub Date : 2025-08-29 eCollection Date: 2025-01-01 DOI:10.2147/RRU.S542550
Kevin Guan, Bassam Dahman, Shyh-Han Tan, Dechang Chen, Andrew J Waters, Gregory T Chesnut, Sean Q Kern, Anwar E Ahmed
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引用次数: 0

Abstract

Objective: Digital Rectal Examination (DRE) remains an important preventive measure in primary care settings, but a single screening may produce false positives. We sought to explore the trend of abnormal DRE (suspicious and non-suspicious) findings in men with and without prostate cancer.

Methods: We utilized data on 34,756 men (1,713 Black and 33,043 White) from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Serial DRE measurements were collected over a 10-year follow-up prior to prostate cancer diagnosis. DRE results were categorized as: normal, abnormal non-suspicious, and suspicious DRE. Generalized estimating equation (GEE) model was used to evaluate the trend in suspicious DRE findings over time.

Results: After adjusting for potential confounders, the interaction term of time to diagnosis and prostate cancer status was statistically significant indicating a 23.0% increase in the odds of suspicious DRE (OR=1.230, 95% CI: 1.193-1.268) and a 5.2% increase in the odds of non-suspicious DRE (OR=1.052, 95% CI: 1.033-1.072) per year closer to diagnosis. The positive predictive value of abnormal suspicious DRE was 4.74% at 10 years prior to diagnosis, 36.82% at 5 years prior to diagnosis, 60.63% at 2 years prior to diagnosis, and 90.48% at diagnosis. Older age and benign prostatic hyperplasia (BPH) were more likely to have increased suspicious DRE findings.

Conclusion: Our results suggest that incorporating serial DRE findings into screening strategies may reduce false positives and improve early detection of clinically significant prostate cancer. This study demonstrates a rising probability of abnormal DRE findings in men with prostate cancer, whereas no temporal change was observed in men without prostate cancer.

Abstract Image

Abstract Image

直肠指检结果和前列腺癌检测的十年趋势:来自PLCO试验的见解。
目的:直肠指检(DRE)仍然是一项重要的预防措施,在初级保健机构,但单一筛选可能产生假阳性。我们试图探讨异常DRE(可疑和非可疑)发现的趋势在男性和非前列腺癌。方法:我们使用了来自前列腺、肺、结直肠和卵巢(PLCO)癌症筛查试验的34,756名男性(1,713名黑人和33,043名白人)的数据。在前列腺癌诊断前的10年随访中收集了一系列DRE测量值。DRE结果分为正常、异常、非可疑和可疑DRE。使用广义估计方程(GEE)模型来评估可疑DRE发现随时间的趋势。结果:在调整潜在混杂因素后,诊断与前列腺癌状态的相互作用时间具有统计学意义,表明离诊断每年可疑DRE的几率增加23.0% (OR=1.230, 95% CI: 1.193-1.268),非可疑DRE的几率增加5.2% (OR=1.052, 95% CI: 1.033-1.072)。异常可疑DRE的阳性预测值在诊断前10年为4.74%,诊断前5年为36.82%,诊断前2年为60.63%,诊断时为90.48%。老年和良性前列腺增生(BPH)更有可能增加可疑的DRE发现。结论:我们的研究结果表明,将系列DRE结果纳入筛查策略可以减少假阳性并提高临床显著前列腺癌的早期发现。本研究表明,前列腺癌患者DRE异常的概率在上升,而非前列腺癌患者DRE异常的概率在上升。
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来源期刊
Research and Reports in Urology
Research and Reports in Urology UROLOGY & NEPHROLOGY-
CiteScore
3.40
自引率
0.00%
发文量
60
审稿时长
16 weeks
期刊介绍: Research and Reports in Urology is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of adult and pediatric urology in the clinic and laboratory including the following topics: Pathology, pathophysiology of urological disease Investigation and treatment of urological disease Pharmacology of drugs used for the treatment of urological disease Although the main focus of the journal is to publish research and clinical results in humans; preclinical, animal and in vitro studies will be published where they will shed light on disease processes and potential new therapies. Issues of patient safety and quality of care will also be considered.
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