Quantifying the Clinical Utility of the Digital Rectal Exam in the Age of PSA Screening
We would like to examine a large database of men screened for prostate cancer with both DRE and serum PSA. We would then determine how many men with "normal" PSA levels went on to have a prostate biopsy due to an abnormal DRE. Of the men with a normal PSA and abnormal DRE who undergo biopsy, we would seek to determine which of these men had cancer found on the same side as the perceived abnormality. Of these individuals, we will identify the subset of men found to have both clinically significant prostate cancer and a life expectancy that would warrant definite treatment. Ultimately, we will then compare this to the number of men whose prostate cancer was detected by an "abnormal" PSA screening value to help determine the overall contribution of the DRE to the prostate cancer screening process.
To quantify the continued role of the digital rectal examination in the prostate cancer screening process by determining the chance of identifying a clinically significant prostate cancer by screening DRE in a population of men with "normal" PSA levels and a life expectancy to justify definitive therapy.
Robert Kovell, MD
Tao Cui, MD