Digital rectal examination as preliminary evaluation of local stage of prostate cancer prior to radical prostatectomy
Article published in Urologia Polska 2007/60/1.
Zbigniew Wolski, Łukasz Pokrywka, Michał Bryczkowski, Tomasz Drewa
- Katedra i Klinika Urologii Ogólnej, Onkologicznej i Dziecięcej Collegium Medicum w Bydgoszczy
Uniwersytetu Mikołaja Kopernika w Toruniu
prostate, prostate cancer, digital rectal examination, radical prostatectomy
- Introduction. Estimation of the local stage of the prostate cancer is a crucial point during qualifying the patient for radical treatment.
- The aim of the study. Aim of the study was to estimate prostate cancer stage based on the digital rectal examination in patients treated with radical prostatectomy.
- Material and method. From January 2002 to June 2004 69 patients were subjected to radical prostatectomy due to prostate cancer diagnosed by ultrasound guided biopsy. Digital rectal examination was done in all patients before the treatment performed by the same experienced urologist. 30 patients with palpable tumor (DRE +) were included to the 1st group. 2nd group consisted of 39 patients with normal digital rectal examination (DRE -). 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. Spearman and Kendall correlation coefficient between abnormal digital rectal examination and prostate capsular invasion amounts 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% of 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.
- Noldus J, Palisaar J, Huland H: Treatment of prostate cancer - the clinical use of radical prostatectomy. EAU Update Series 2003, 1, 16-22.
- Han M, Partin AW, Zahurak M et al: Biochemical (prostate specific antygen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol 2003, 169 (2), 517-523.
- Amling CL: Advanced prostate cancer treatment guidelines, a United States perspective. BJU Int 2004, 3, 7-8.
- Kattan MW, Wheeler TM, Scardino PT: Postoperative nomogram for disease recurrence after radical proctatectomy for prostate cancer. J Clin Onkol 1999, 17, 1499-1507.
- D´Amico AV, Moul J, Carroll PR et al: Cancer specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed during the prostate-specific antigen era. J Clin Oncol 2003, 21, 2163-2172.
- Partin AW, Mangold LA, Lamm DM: Contemporary update of the prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology 2001, 58, 843-848.
- Collins GN, Lloyd SN, Hehir M, McKelvie GB: Multiple transrectal ultrasound-guided biopsies - true morbidity and patient acceptance. Br J Urol 1993, 71, 460-463.
- Roscigno M, Scattoni V, Bertini R et al: Diagnosis of prostate cancer. State of the art. Minerva Urol Nefrol 2004, 56 (2), 123-145.
- Schulman CC, Zlotta AR, Dennis L et al: Prevention of prostate cancer. Scand J Urol Nephrol 2003, 205 (Suppl), 50-61.
- Gerber GS, Chodak GW. Routine screening for cancer of the prostate. J Natl Cancer Inst 1991, 83,329-35.
- Demura T, Hioka T, Furuno T et al: Differences in carcinoma core dystrybution between palpable and nonpalpable prostate tumors in patients diagnosed using extensive transperineal ultrasound-guided template prostate biopsy. Cancer 2005, 103 (9), 1826-1832.
- Spigelman SS, McNeal JE, Freiha FS, Stamey TA: Rectal examination in volume determination of carcinoma of the prostate, clinical and anatomical correlations. J Urol 1986, 136, 1228-1230.
- Philip J, Dutta Roy S, Ballal M et al: Is a digital rectal examination necessary in the diagnosis and clinical staging of early prostate cancer? BJU Int 2005, 95 (7), 969-971.
- Ravery V, Boccon-Gibod L: T3 prostate cancer, how reliable is clinical staging? Semin Urol Oncol 1997, 15 (4), 202-206.
- Okihara K, Kamoi K, Lane RB et al: Role of systematic ultrasound-guided staging biopsies in predicting extraprostatic extension and seminal vesicle invasion in men with prostate cancer. J Clin Ultrasound 2002, 30 (3), 123-131.
- Bozeman CB, Carver BS, Caldito G et al: Prostate cancer in patients with an abnormal digital rectal examination and serum prostate-sphecific antigen less than 4.0 ng/ml. Urology 2005, 66 (4), 803-807.
- Carvalhal GF, Smith DS, Mager DE et al: Digital rectal examination for detecting prostate cancer at prostate specific antigen levels of 4 ng/ml or less. J Urol 1999, 161, 835-839.
- Fowler JE Jr, Bigler SA, Farabaugh PB et al: Prostate cancer detection in black and white men with abnormal digital rectal examination and prostate specific antigen less than 4 ng/ml. J Urol 2000, 164, 1961-1963.
- Schroder FH, van der Cruijsen-Koeter I, de Koning HJ et al: Prostate cancer detection at low prostate specific antigen. J Urol 2000, 163, 806-812.
- Colombo T, Schips L, Augustin H et al: Value of transrectal ultrasound in preoperative staging of prostate cancer. Minerva Urol Nefrol 1999, 51 (1), 1-4.
- Zdrojowy R: Postępowanie terapeutyczne w przypadku raka stercza zaawansowanego miejscowo - własna koncepcja rozszerzonej radykalnej prostatektomii połączonej z indukcyjną i uzupełniającą maksymalną blokadą androgenową. Rozprawa habilitacyjna, 2000.
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