The digital rectal examination is a procedure where a physician feels the surface of the prostate with a gloved finger. The doctor is able to feel any lumps or hard areas on the prostate.
A PSA test checks for levels of prostate-specific antigen in the blood, with higher levels signaling potential cancer. As men age, the acceptable PSA level increases.
"Prostate cancer is the most common cancer in men, accounting for over 28,000 deaths yearly," said Jay Raman, M.D., associate professor of surgery. "Improvements in screening methodology and refinements in cancer care have contributed, in part, to a reduction in recent mortality rates."
An elevated PSA level or an abnormality found on the prostate during the digital rectal exam typically leads to the recommendation of prostate needle biopsy, the most accurate diagnostic technique. Elevated PSA levels have been shown to more accurately predict a positive cancer biopsy result than the rectal exam. The digital rectal exam has been considered less precise because of the variability in of who is administersing the test and the experience of that person, and the incorrect positives associated with noncancerous abnormalities.
Other studies have shown the PSA test to be more sensitive and specific than the digital rectal exam, especially at low PSA levels. However, no study to the researchers' knowledge has looked at the effectiveness of the digital rectal exam when compared to age-adjusted PSA levels.
Penn State Hershey researchers studied 806 men from September 2001 to December 2008 to see how the initial testing lined up with the results of their biopsies.
In the group of men studied, half had elevated PSA levels and 36 percent had an abnormal digital rectal exam (with or without an elevated PSA). The biopsy diagnosed 306 of the men as having prostate cancer. Of that number, 136 of the men had an abnormal digital rectal exam finding.
Most importantly, 43 of the 136 men who had an abnormal digital rectal exam showed a normal PSA level for their age. While 14 percent of all patients with prostate cancer had an abnormal digital rectal exam, 31 percent of these men had normal PSA levels for their age.
"It is important to acknowledge that age-specific PSA cutoffs contribute some limitations in prostate cancer screening," Raman said. "In particular, while age-specific thresholds increase the sensitivity in younger men, these same cutoff values lower the sensitivity in older men."
Because the acceptable PSA level is increased for older men, it is possible that prostate cancer is being missed if only the PSA test is used.
"Our study confirms that the digital rectal exam remains an important part of screening such patients because 31 percent of cancers in our study would have been missed by using age-specific PSA cutoffs alone," Raman said.
Researchers published their findings in The Canadian Journal of Urology.
Other researchers are Ricardo Palmerola, M.D., and Nikolina Icitovic, M.D., students, Penn State College of Medicine; and Paul Smith, M.D., Vanessa Elliot, M.D., Carl T. Reese, M.D., Frank B. Mahon, M.D., Lewis E. Harpster, M.D., all of Division of Urology, Penn State Milton S. Hershey Medical Center.
Matthew Solovey | EurekAlert!
Visualizing gene expression with MRI
23.12.2016 | California Institute of Technology
Illuminating cancer: Researchers invent a pH threshold sensor to improve cancer surgery
21.12.2016 | UT Southwestern Medical Center
An important step towards a completely new experimental access to quantum physics has been made at University of Konstanz. The team of scientists headed by...
Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...
Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.
While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...
Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales
Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...
Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.
As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...
19.01.2017 | Event News
10.01.2017 | Event News
09.01.2017 | Event News
19.01.2017 | Ecology, The Environment and Conservation
19.01.2017 | Awards Funding
19.01.2017 | Studies and Analyses