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Comparing the Performance of Digital Rectal Examination and Prostate-Specific Antigen As a Screening Test for Prostate Cancer: A Systematic Review and Meta-Analysis Publisher Pubmed



Matsukawa A1, 3, 5, 7, 9, 11, 13, 18, 20 ; Yanagisawa T1, 3, 5, 7, 9, 11, 13, 18, 20 ; Bekku K1, 3, 5, 7, 9, 11, 13, 18, 20 ; Kardoust Parizi M1, 3, 5, 7, 9, 11, 13, 18, 20 ; Laukhtina E1, 3, 5, 7, 9, 11, 13, 18, 20 ; Klemm J1, 3, 5, 7, 9, 11, 13, 18, 20 ; Chiujdea S1, 3, 5, 7, 9, 11, 13, 18, 20 ; Mori K1, 3, 5, 7, 9, 11, 13, 18, 20 ; Kimura S1, 3, 5, 7, 9, 11, 13, 18, 20 ; Fazekas T1, 3, 5, 7, 9, 11, 13, 18, 20 ; Miszczyk M15 ; Miki J16 ; Kimura T16 ; Karakiewicz PI17 Show All Authors
Authors
  1. Matsukawa A1, 3, 5, 7, 9, 11, 13, 18, 20
  2. Yanagisawa T1, 3, 5, 7, 9, 11, 13, 18, 20
  3. Bekku K1, 3, 5, 7, 9, 11, 13, 18, 20
  4. Kardoust Parizi M1, 3, 5, 7, 9, 11, 13, 18, 20
  5. Laukhtina E1, 3, 5, 7, 9, 11, 13, 18, 20
  6. Klemm J1, 3, 5, 7, 9, 11, 13, 18, 20
  7. Chiujdea S1, 3, 5, 7, 9, 11, 13, 18, 20
  8. Mori K1, 3, 5, 7, 9, 11, 13, 18, 20
  9. Kimura S1, 3, 5, 7, 9, 11, 13, 18, 20
  10. Fazekas T1, 3, 5, 7, 9, 11, 13, 18, 20
  11. Miszczyk M15
  12. Miki J16
  13. Kimura T16
  14. Karakiewicz PI17
  15. Rajwa P1, 3, 5, 7, 9, 11, 13, 18, 20
  16. Shariat SF1, 3, 5, 7, 9, 11, 13, 18, 20
Show Affiliations
Authors Affiliations
  1. 1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  2. 2. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
  3. 3. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  4. 4. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  5. 5. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  6. 6. Department of Urology, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
  7. 7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  8. 8. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
  9. 9. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  10. 10. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  11. 11. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  12. 12. Department of Urology, Spitalul Clinic Judetean Murures, University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Mures, Romania
  13. 13. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  14. 14. Department of Urology, Semmelweis University, Budapest, Hungary
  15. 15. Third Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
  16. 16. Department of Urology, Jikei University School of Medicine, Tokyo, Japan
  17. 17. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
  18. 18. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  19. 19. Department of Urology, Medical University of Silesia, Zabrze, Poland
  20. 20. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  21. 21. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
  22. 22. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
  23. 23. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
  24. 24. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia
  25. 25. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

Source: European urology oncology Published:2024


Abstract

BACKGROUND AND OBJECTIVE: Although digital rectal examination (DRE) is recommended in combination with prostate-specific antigen (PSA) for detection of prostate cancer (PCa), there are limited data to support its use as a screening/early detection test. Our objective was to assess the diagnostic value of DRE in screening for early detection of PCa. METHODS: In August 2023, we queried the PubMed, Scopus, and Web of Science databases to identify prospective studies simultaneously investigating the diagnostic performance of DRE and PSA for PCa screening. The primary endpoints were the positive predictive value (PPV) and cancer detection rate (CDR) of DRE. Secondary endpoints included the PPV and CDR of both PSA alone and in combination with DRE. We conducted meta-regression analysis to compare the CDR and PPV of different screening strategies. This meta-analysis is registered on PROSPERO (CRD42023446940). KEY FINDINGS AND LIMITATIONS: We identified eight studies involving 85,798 participants, of which three were randomized controlled trials and five were prospective diagnostic studies, that reported the PPV and CDR of both DRE and PSA for the same cohort. Our analysis revealed a pooled PPV of 0.21 (95% confidence interval [CI] 0.13-0.33) for DRE, which is similar to the PPV of PSA (0.22, 95% CI 0.15-0.30; p = 0.9), with no benefit from combining DRE and PSA (PPV 0.19, 95% CI 0.13-0.26; p = 0.5). However, the CDR of DRE (0.01, 95% CI: 0.01-0.02) was significantly lower than that of PSA (0.03, 95% CI 0.02-0.03; p < 0.05) and the combination of DRE and PSA (0.03, 95% CI 0.02-0.04; p < 0.05). The screening strategy combining DRE and PSA was not different to that of PSA alone in terms of CDR (p = 0.5) and PPV (p = 0.5). CONCLUSIONS AND CLINICAL IMPLICATIONS: Our comprehensive review and meta-analysis indicates that both as an independent test and as a supplementary measure to PSA for PCa detection, DRE exhibits a notably low diagnostic value. The collective findings from the included studies suggest that, in the absence of clinical symptoms and signs, DRE could be potentially omitted from PCa screening and early detection strategies. PATIENT SUMMARY: Our review shows that the screening performance of digital rectal examination for detection of prostate cancer is not particularly impressive, suggesting that it might not be necessary to conduct this examination routinely. Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.