CODE: 7.2 - Digital rectal examination as preliminary evaluation of local stage of the prostate cancer prior to radical prostatectomy
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Zbigniew Wolski, Łukasz Pokrywka, Michał Bryczkowski

Katedra i Klinika Urologii Ogólnej, Onkologicznej i Dziecięcej CM UMK w Bydgoszczy

summary

Introduction. Estimation of local stage of prostate cancer is crucial point to qualify patients for radical treatment.

The aim of the study. Aim of the study was to estimate prostate cancer stage by digital rectal examination in patients treated with radical prostatectomy.

Material and method. From January 2002 to June 2004 69 patients were treated with radical prostatectomy in Department of Urology CM UMK in Bydgoszcz because of prostate cancer diagnosed by ultrasound guided biopsy. The range of age was 42-72 years (av. 61.9). The range of PSA level was 1-53 ng/ml (av. 10.61). Digital rectal examination was done in all patients before the treatment by the same experienced urologist. Patients with palpable tumor (DRE +) were included to the 1st group. 2nd group consisted of patients with normal digital rectal examination (DRE -). Patients with suspicion of extracapsular extension in DRE and/or TRUS and/or CT/MRI and patients not qualified to radical prostatectomy were excluded from the study. T stage and Gleason score were done before and after the treatment. PSA level, T stage and Gleason score were compared between both groups.

Results. 1st group (DRE +) comprised of 30 patients (43.5%). All patients were diagnosed as cT2a. The range of PSA level was 1 to 53 ng/ml (av. 10.77 ng/ml) in this group. Biopsy resulted in 2 to 6 Gleason score in 22 patients (73.4%), 7 and more Gleason score in 4 patients (13.3%). 4 patients (13.3%) had no Gleason score (Gx). Radical prostatectomy resulted in pT2 in 18 patients (60%), pT3 - 10 (33.3%), pT4 - 2 (6.7%). Gleason score after radical prostatectomy was 3 to 6 in 18 patients (60%), 7 and more in 11 patients (36.7%), Gx in 1 patient (3.3%). The 2nd group (DRE -) comprised of 39 patients (56.5%) diagnosed as cT1c. The range of PSA level was 4.4 to 27.5 ng/ml (av. 10.5 ng/ml). Biopsy resulted in 2 to 6 Gleason score in 33 patients (84.5%), 7 and more Gleason score in 4 patients (10.3%). 2 patients (5.2%) had no Gleason score (Gx). Radical prostatectomy resulted in pT2 in 35 patients (89.7%), pT3 - 4 (10.3%), pT4 - 0 (0%). Gleason score after radical prostatectomy was 3 to 6 in 30 patients (76.9%), 7 and more in 9 patients (23.1%). Spearman and Kendall correlation coefficient between abnormal digital rectal examination and prostate capsular invasion amount to 0.35 and is statistically significant.

Conclusions. 1. Palpable tumor in digital rectal examination clinically estimated as cT2c was associated with capsular invasion in 40% patients treated with radical prostatectomy. 2. Positive digital rectal examination (DRE +) indicates high probability of prostate capsular invasion. This probability is 4 times higher when compared to DRE (-) group. 3. There is statistical significance between abnormal digital rectal examination and prostate capsular invasion. 4. DRE (+) patients belong to high-risk group in the term of local recurrence.