Digital rectal grading of benign prostatic hyperplasia: Where does it stand today?

Background: Despite the fact that digital rectal examination (DRE) is an integral part of medical teaching curriculum, there is lack of standardized grading system for benign prostatic hyperplasia (BPH) that can be followed uniformly. Aims: To evaluate the validity of digital rectal grading for the assessment of prostate volume, in view to improve its reproducibility. Materials and Methods: This study was carried out in 150 eligible patients of BPH. Based on DRE the prostate enlargement was stratified into four grades. The degree of agreement between the expected prostate volume and measured prostate volume against each digital rectal grade were analyzed using Scatter plots. Data were analyzed using the Statistical Package for the Social Sciences. Results: The digital rectal Grades I-IV correlates well with transrectal ultrasound measurement and roughly corresponds to a volume of 27.78 ± 2.55 ml, 40.54 ± 7.69 ml, 61.08 ± 11.90 ml and 98.42 ± 23.44 ml, respectively. The expected prostate volume in digital rectal Grade II (30-50 ml) showed an underestimation and overestimation by 4.76% and 7.94%, respectively. Similarly, Grade III (expected 50-85 ml) and IV (expected >85 ml) showed overestimation by 22.50% and 23.08% respectively. The Cronbach′s coefficient showed good internal consistency (α = 0. 851). Conclusions: Our attempt for standardization of the digital rectal grading satisfactorily validated in the clinical setting. It is feasibly sufficient to provide a rough estimation of the prostate volume and to classify patients with BPH.