Dataset Information

Does a screening digital rectal exam provide actionable clinical utility in patients with an elevated PSA and positive MRI?

ABSTRACT:

Objective

To define the value of a digital rectal exam (DRE) in the prostate-magnetic resonance imaging (MRI) era. Prostate MRI is increasingly used in men with elevated prostate-specific antigen (PSA) prior to biopsy.

Methods

A retrospective study was performed in men with elevated PSA undergoing MRI followed by MRI fusion with systematic biopsy and men with elevated PSA/active surveillance with negative MRI followed by biopsy. Baseline clinicopathologic characteristics and DRE findings were collected. We examined performance of a positive DRE on sensitivity and specificity of diagnosing clinically significant prostate cancer (CSPC).

Results

A total of 339 patients had elevated PSA and positive MRI followed by MRI fusion guided with systematic biopsy. Pre-biopsy DRE was documented in 286/339 patients, who were included in further analysis. About 81.6% positive, 78.7% questionable, and 55.8% negative DRE patients had CSPC. Positive DRE had 21.8% sensitivity and 91.3% specificity for CSPC. Positive or questionable DRE had 42.1% sensitivity and 81.5% specificity. Among 148 men with non-CSPC (GG1)-targeted biopsy, 28 had systematic biopsy with CSPC. About 5/28 had positive DRE and 8/28 had positive or questionable DRE. Twenty-seven patients were included who had elevated PSA/on active surveillance with negative MRI and biopsy done within 2 years. About 77.8% had negative, 7.4% had questionable, and 14.8% men had positive DRE. About 7.4% had CSPC and all had a negative DRE.

Conclusions

Our study provides limited evidence for the value of a DRE. However, it does show occasional benefit in detecting GG2 or higher disease and given the lack of cost and side effects, should still be considered.

SUBMITTER: Chang CM

PROVIDER: S-EPMC8988521 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

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Publications

Does a screening digital rectal exam provide actionable clinical utility in patients with an elevated PSA and positive MRI?

Chang Courtney M CM McIntosh Andrew G AG Shapiro Daniel D DD Davis John W JW Ward John F JF Gregg Justin R JR

BJUI compass 20210504 3

<h4>Objective</h4>To define the value of a digital rectal exam (DRE) in the prostate-magnetic resonance imaging (MRI) era. Prostate MRI is increasingly used in men with elevated prostate-specific antigen (PSA) prior to biopsy.<h4>Methods</h4>A retrospective study was performed in men with elevated PSA undergoing MRI followed by MRI fusion with systematic biopsy and men with elevated PSA/active surveillance with negative MRI followed by biopsy. Baseline clinicopathologic characteristics and DRE f ...[more]

PMID: 35475129

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Project description:Purpose"Mag-paDRE" is a yearly prostate health public awareness program initiated by the Philippine Urological Association. This study aimed to describe the demographic and clinical data of the participants in the 2013 "Mag-paDRE" program and to identify factors that will further improve prostate health public awareness.MethodsA descriptive cross-sectional study undertaken to collect and assess the demographic data, International Prostate Symptom Score (IPSS) and digital rectal examination findings of the participants in the "Mag-paDRE" conducted in the 10 Philippine Board of Urology (PBU) different accredited training institutions. Descriptive statistics was used to report the proportion of Filipino men aged 40 or older who presented for their first prostate health evaluation. Clinical profile were reviewed and summarized. The study protocol was registered in the Clinicaltrial.gov under Identifier NCT01886547.ResultsA total of 925 participants from the 10 PBU accredited training institutions were assessed. Among the 10 training institutions the large tertiary government owned medical center had the highest number of participants and target participants recruited; while the private sectors owned tertiary hospitals have the highest proportion of target participants and cases. According to the predetermined definition of this study, 614 (66%) were considered the target population for the "Mag-paDRE" program. The mean age of the target participants was 58.9±9.9. Only 360 of 614 (59%) were new case, 118 (32.7%) had severe lower urinary tract symptoms (LUTS), 223 (62%) had moderate LUTS, 19 (5.3%) were asymptomatic but with hard prostates, palpable prostate nodules or prostate tenderness. The most bothersome symptoms were incomplete bladder emptying (30.2%), and frequency (22.9%).ConclusionsOverall, the 2013 "Mag-paDRE" among the 10 training institutions was effective in promoting prostate health awareness. A need to modify the preactivity information dissemination by these institutions can be done to further increase the attendance of targeted population of the prostate health awareness program.

Project description:BACKGROUND:MRI is commonly used to evaluate pediatric musculoskeletal pathologies, but same-day/near-term scheduling and short exams remain challenges. PURPOSE:To investigate the feasibility of a targeted rapid pediatric knee MRI exam, with the goal of reducing cost and enabling same-day MRI access. STUDY TYPE:A cost effectiveness study done prospectively. SUBJECTS:Forty-seven pediatric patients. FIELD STRENGTH/SEQUENCE:3T. The 10-minute protocol was based on T2 Shuffling, a four-dimensional acquisition and reconstruction of images with variable T2 contrast, and a T1 2D fast spin-echo (FSE) sequence. A distributed, compressed sensing-based reconstruction was implemented on a four-node high-performance compute cluster and integrated into the clinical workflow. ASSESSMENT:In an Institutional Review Board-approved study with informed consent/assent, we implemented a targeted pediatric knee MRI exam for assessing pediatric knee pain. Pediatric patients were subselected for the exam based on insurance plan and clinical indication. Over a 2-year period, 47 subjects were recruited for the study and 49 MRIs were ordered. Date and time information was recorded for MRI referral, registration, and completion. Image quality was assessed from 0 (nondiagnostic) to 5 (outstanding) by two readers, and consensus was subsequently reached. STATISTICAL TESTS:A Wilcoxon rank-sum test assessed the null hypothesis that the targeted exam times compared with conventional knee exam times were unchanged. RESULTS:Of the 49 cases, 20 were completed on the same day as exam referral. Median time from registration to exam completion was 18.7 minutes. Median reconstruction time for T2 Shuffling was reduced from 18.9 minutes to 95 seconds using the distributed implementation. Technical fees charged for the targeted exam were one-third that of the routine clinical knee exam. No subject had to return for additional imaging. DATA CONCLUSION:The targeted knee MRI exam is feasible and reduces the imaging time, cost, and barrier to same-day MRI access for pediatric patients. LEVEL OF EVIDENCE:2 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019.

Dataset Information

Does a screening digital rectal exam provide actionable clinical utility in patients with an elevated PSA and positive MRI?

Objective

Methods

Results

Conclusions

Publications

Does a screening digital rectal exam provide actionable clinical utility in patients with an elevated PSA and positive MRI?

Similar Datasets

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