Digital rectal examination impact on PSA derivatives and prostate biopsy triggers: a contemporary study
Objective To evaluate the impact of the digital rectal exam (DRE) on PSA measurements and clinical decision-making. Methods Healthy male volunteers between 50 and 70 years old were recruited during a 30-day public screening program. PSA levels were measured using two different methods (standard enha...
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| Veröffentlicht in: | International urology and nephrology 2022-09, Vol.54 (9), p.2117-2123 |
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| creator | da Silva Junior, Maurício Moreira Capibaribe, Diego Moreira Avilez, Natalia Dalsenter Jalalizadeh, Mehrsa Dias, Luiza Bortoloti Laranja, Walker W. Guimarães, Fabio Simões, Fabiano A. Alonso, João C. C. Rejowski, Ronald F. Cintra, Adriano Reis, Leonardo O. |
| description | Objective
To evaluate the impact of the digital rectal exam (DRE) on PSA measurements and clinical decision-making.
Methods
Healthy male volunteers between 50 and 70 years old were recruited during a 30-day public screening program. PSA levels were measured using two different methods (standard enhanced chemiluminescence immunoassay—ECLIA, and novel immunochromatography assay—ICA/rapid PSA) in the same blood sample. Two blood samples were drawn; first before DRE and the second 30–40 min after DRE. The effect of DRE on PSA levels and its impact on clinical decision-making for individual patients were evaluated based on different biopsy trigger cutoffs.
Results
ECLIA-PSA was measured in 74 participants both pre- and 37 ± 5 min post-DRE, mean age 57.2 ± 8.3 years, and mean prostate volume 33.6 (20–80) cm
3
. Both total and free ECLIA-PSA increased significantly after DRE (mean increase of 0.47 and 0.26 ng/ml, respectively, both
p
3 ng/ml, 13 increase > 0.75 ng/ml, 3 PSA density > 0.15, and 1 free/total PSA 0.18. ICA-PSA was detectable (> 2.0 ng/ml) in 5 of 45 measured samples (11%) before DRE and 13/45 (29%) after DRE,
p
= 0.0316. Four among five detectable ICA-PSA tests increased after DRE.
Conclusion
Performing DRE immediately before PSA measurement might change the clinical decision-making on a significant number of occasions (roughly 1 in 3); even though the mean increase (0.47 ng/ml) looks deceivingly small. Further studies are required that include gold standard tests (biopsy, or imaging). |
| doi_str_mv | 10.1007/s11255-022-03283-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2685030106</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2685030106</sourcerecordid><originalsourceid>FETCH-LOGICAL-c303t-2b9233e693c02808cde37890643dd22ba4f04cf168a533e8745c5208c9a02553</originalsourceid><addsrcrecordid>eNp9kE1LxDAQhoMouH78AU8BL16qk6RpU2_L-gkLCu49ZNO0ZOmXSbq4_96sFRQPnmZgnhneeRC6IHBNAPIbTwjlPAFKE2BUsIQfoBnhOUsoF-nhr_4YnXi_AYBCAMxQfWdrG1SDndH7Yj5UazsVbN9h2w5KBxy717c5Lo2z2zjYGo9VV-LB9T6oYPDa9oPf4eBsXRvnb7HCuu-CaYfeKbfDPozl7gwdVarx5vy7nqLVw_1q8ZQsXx6fF_NlohmwkNB1QRkzWcE0UAFCl4blooAsZWVJ6VqlFaS6IplQPHIiT7nmNHKFgiiAnaKr6WxM9z4aH2RrvTZNozrTj17STHBgQCCL6OUfdNOProvhJM2jHhAiE5GiE6Xju96ZSg7OtvEtSUDu1ctJvYzq5Zd6uU_BpiUf4S5K-Tn9z9Yn2ZOGRQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2700908868</pqid></control><display><type>article</type><title>Digital rectal examination impact on PSA derivatives and prostate biopsy triggers: a contemporary study</title><source>SpringerLink Journals</source><creator>da Silva Junior, Maurício Moreira ; Capibaribe, Diego Moreira ; Avilez, Natalia Dalsenter ; Jalalizadeh, Mehrsa ; Dias, Luiza Bortoloti ; Laranja, Walker W. ; Guimarães, Fabio ; Simões, Fabiano A. ; Alonso, João C. C. ; Rejowski, Ronald F. ; Cintra, Adriano ; Reis, Leonardo O.</creator><creatorcontrib>da Silva Junior, Maurício Moreira ; Capibaribe, Diego Moreira ; Avilez, Natalia Dalsenter ; Jalalizadeh, Mehrsa ; Dias, Luiza Bortoloti ; Laranja, Walker W. ; Guimarães, Fabio ; Simões, Fabiano A. ; Alonso, João C. C. ; Rejowski, Ronald F. ; Cintra, Adriano ; Reis, Leonardo O.</creatorcontrib><description>Objective
To evaluate the impact of the digital rectal exam (DRE) on PSA measurements and clinical decision-making.
Methods
Healthy male volunteers between 50 and 70 years old were recruited during a 30-day public screening program. PSA levels were measured using two different methods (standard enhanced chemiluminescence immunoassay—ECLIA, and novel immunochromatography assay—ICA/rapid PSA) in the same blood sample. Two blood samples were drawn; first before DRE and the second 30–40 min after DRE. The effect of DRE on PSA levels and its impact on clinical decision-making for individual patients were evaluated based on different biopsy trigger cutoffs.
Results
ECLIA-PSA was measured in 74 participants both pre- and 37 ± 5 min post-DRE, mean age 57.2 ± 8.3 years, and mean prostate volume 33.6 (20–80) cm
3
. Both total and free ECLIA-PSA increased significantly after DRE (mean increase of 0.47 and 0.26 ng/ml, respectively, both
p
< 0.001). Different internationally accepted biopsy triggers were reached after DRE only: 5 total PSA > 3 ng/ml, 13 increase > 0.75 ng/ml, 3 PSA density > 0.15, and 1 free/total PSA < 0.18. On two occasions, patients were pushed away from biopsy trigger after DRE due to free/total PSA > 0.18. ICA-PSA was detectable (> 2.0 ng/ml) in 5 of 45 measured samples (11%) before DRE and 13/45 (29%) after DRE,
p
= 0.0316. Four among five detectable ICA-PSA tests increased after DRE.
Conclusion
Performing DRE immediately before PSA measurement might change the clinical decision-making on a significant number of occasions (roughly 1 in 3); even though the mean increase (0.47 ng/ml) looks deceivingly small. Further studies are required that include gold standard tests (biopsy, or imaging).</description><identifier>ISSN: 1573-2584</identifier><identifier>ISSN: 0301-1623</identifier><identifier>EISSN: 1573-2584</identifier><identifier>DOI: 10.1007/s11255-022-03283-5</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Biopsy ; Chemiluminescence ; Clinical decision making ; Decision making ; Medicine ; Medicine & Public Health ; Nephrology ; Patients ; Prostate ; Prostate cancer ; Rectum ; Urology ; Urology - Original Paper</subject><ispartof>International urology and nephrology, 2022-09, Vol.54 (9), p.2117-2123</ispartof><rights>The Author(s), under exclusive licence to Springer Nature B.V. 2022</rights><rights>The Author(s), under exclusive licence to Springer Nature B.V. 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c303t-2b9233e693c02808cde37890643dd22ba4f04cf168a533e8745c5208c9a02553</cites><orcidid>0000-0003-2092-414X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11255-022-03283-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11255-022-03283-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids></links><search><creatorcontrib>da Silva Junior, Maurício Moreira</creatorcontrib><creatorcontrib>Capibaribe, Diego Moreira</creatorcontrib><creatorcontrib>Avilez, Natalia Dalsenter</creatorcontrib><creatorcontrib>Jalalizadeh, Mehrsa</creatorcontrib><creatorcontrib>Dias, Luiza Bortoloti</creatorcontrib><creatorcontrib>Laranja, Walker W.</creatorcontrib><creatorcontrib>Guimarães, Fabio</creatorcontrib><creatorcontrib>Simões, Fabiano A.</creatorcontrib><creatorcontrib>Alonso, João C. C.</creatorcontrib><creatorcontrib>Rejowski, Ronald F.</creatorcontrib><creatorcontrib>Cintra, Adriano</creatorcontrib><creatorcontrib>Reis, Leonardo O.</creatorcontrib><title>Digital rectal examination impact on PSA derivatives and prostate biopsy triggers: a contemporary study</title><title>International urology and nephrology</title><addtitle>Int Urol Nephrol</addtitle><description>Objective
To evaluate the impact of the digital rectal exam (DRE) on PSA measurements and clinical decision-making.
Methods
Healthy male volunteers between 50 and 70 years old were recruited during a 30-day public screening program. PSA levels were measured using two different methods (standard enhanced chemiluminescence immunoassay—ECLIA, and novel immunochromatography assay—ICA/rapid PSA) in the same blood sample. Two blood samples were drawn; first before DRE and the second 30–40 min after DRE. The effect of DRE on PSA levels and its impact on clinical decision-making for individual patients were evaluated based on different biopsy trigger cutoffs.
Results
ECLIA-PSA was measured in 74 participants both pre- and 37 ± 5 min post-DRE, mean age 57.2 ± 8.3 years, and mean prostate volume 33.6 (20–80) cm
3
. Both total and free ECLIA-PSA increased significantly after DRE (mean increase of 0.47 and 0.26 ng/ml, respectively, both
p
< 0.001). Different internationally accepted biopsy triggers were reached after DRE only: 5 total PSA > 3 ng/ml, 13 increase > 0.75 ng/ml, 3 PSA density > 0.15, and 1 free/total PSA < 0.18. On two occasions, patients were pushed away from biopsy trigger after DRE due to free/total PSA > 0.18. ICA-PSA was detectable (> 2.0 ng/ml) in 5 of 45 measured samples (11%) before DRE and 13/45 (29%) after DRE,
p
= 0.0316. Four among five detectable ICA-PSA tests increased after DRE.
Conclusion
Performing DRE immediately before PSA measurement might change the clinical decision-making on a significant number of occasions (roughly 1 in 3); even though the mean increase (0.47 ng/ml) looks deceivingly small. Further studies are required that include gold standard tests (biopsy, or imaging).</description><subject>Biopsy</subject><subject>Chemiluminescence</subject><subject>Clinical decision making</subject><subject>Decision making</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Nephrology</subject><subject>Patients</subject><subject>Prostate</subject><subject>Prostate cancer</subject><subject>Rectum</subject><subject>Urology</subject><subject>Urology - Original Paper</subject><issn>1573-2584</issn><issn>0301-1623</issn><issn>1573-2584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kE1LxDAQhoMouH78AU8BL16qk6RpU2_L-gkLCu49ZNO0ZOmXSbq4_96sFRQPnmZgnhneeRC6IHBNAPIbTwjlPAFKE2BUsIQfoBnhOUsoF-nhr_4YnXi_AYBCAMxQfWdrG1SDndH7Yj5UazsVbN9h2w5KBxy717c5Lo2z2zjYGo9VV-LB9T6oYPDa9oPf4eBsXRvnb7HCuu-CaYfeKbfDPozl7gwdVarx5vy7nqLVw_1q8ZQsXx6fF_NlohmwkNB1QRkzWcE0UAFCl4blooAsZWVJ6VqlFaS6IplQPHIiT7nmNHKFgiiAnaKr6WxM9z4aH2RrvTZNozrTj17STHBgQCCL6OUfdNOProvhJM2jHhAiE5GiE6Xju96ZSg7OtvEtSUDu1ctJvYzq5Zd6uU_BpiUf4S5K-Tn9z9Yn2ZOGRQ</recordid><startdate>20220901</startdate><enddate>20220901</enddate><creator>da Silva Junior, Maurício Moreira</creator><creator>Capibaribe, Diego Moreira</creator><creator>Avilez, Natalia Dalsenter</creator><creator>Jalalizadeh, Mehrsa</creator><creator>Dias, Luiza Bortoloti</creator><creator>Laranja, Walker W.</creator><creator>Guimarães, Fabio</creator><creator>Simões, Fabiano A.</creator><creator>Alonso, João C. C.</creator><creator>Rejowski, Ronald F.</creator><creator>Cintra, Adriano</creator><creator>Reis, Leonardo O.</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2092-414X</orcidid></search><sort><creationdate>20220901</creationdate><title>Digital rectal examination impact on PSA derivatives and prostate biopsy triggers: a contemporary study</title><author>da Silva Junior, Maurício Moreira ; Capibaribe, Diego Moreira ; Avilez, Natalia Dalsenter ; Jalalizadeh, Mehrsa ; Dias, Luiza Bortoloti ; Laranja, Walker W. ; Guimarães, Fabio ; Simões, Fabiano A. ; Alonso, João C. C. ; Rejowski, Ronald F. ; Cintra, Adriano ; Reis, Leonardo O.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c303t-2b9233e693c02808cde37890643dd22ba4f04cf168a533e8745c5208c9a02553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Biopsy</topic><topic>Chemiluminescence</topic><topic>Clinical decision making</topic><topic>Decision making</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Nephrology</topic><topic>Patients</topic><topic>Prostate</topic><topic>Prostate cancer</topic><topic>Rectum</topic><topic>Urology</topic><topic>Urology - Original Paper</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>da Silva Junior, Maurício Moreira</creatorcontrib><creatorcontrib>Capibaribe, Diego Moreira</creatorcontrib><creatorcontrib>Avilez, Natalia Dalsenter</creatorcontrib><creatorcontrib>Jalalizadeh, Mehrsa</creatorcontrib><creatorcontrib>Dias, Luiza Bortoloti</creatorcontrib><creatorcontrib>Laranja, Walker W.</creatorcontrib><creatorcontrib>Guimarães, Fabio</creatorcontrib><creatorcontrib>Simões, Fabiano A.</creatorcontrib><creatorcontrib>Alonso, João C. C.</creatorcontrib><creatorcontrib>Rejowski, Ronald F.</creatorcontrib><creatorcontrib>Cintra, Adriano</creatorcontrib><creatorcontrib>Reis, Leonardo O.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>International urology and nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>da Silva Junior, Maurício Moreira</au><au>Capibaribe, Diego Moreira</au><au>Avilez, Natalia Dalsenter</au><au>Jalalizadeh, Mehrsa</au><au>Dias, Luiza Bortoloti</au><au>Laranja, Walker W.</au><au>Guimarães, Fabio</au><au>Simões, Fabiano A.</au><au>Alonso, João C. C.</au><au>Rejowski, Ronald F.</au><au>Cintra, Adriano</au><au>Reis, Leonardo O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Digital rectal examination impact on PSA derivatives and prostate biopsy triggers: a contemporary study</atitle><jtitle>International urology and nephrology</jtitle><stitle>Int Urol Nephrol</stitle><date>2022-09-01</date><risdate>2022</risdate><volume>54</volume><issue>9</issue><spage>2117</spage><epage>2123</epage><pages>2117-2123</pages><issn>1573-2584</issn><issn>0301-1623</issn><eissn>1573-2584</eissn><abstract>Objective
To evaluate the impact of the digital rectal exam (DRE) on PSA measurements and clinical decision-making.
Methods
Healthy male volunteers between 50 and 70 years old were recruited during a 30-day public screening program. PSA levels were measured using two different methods (standard enhanced chemiluminescence immunoassay—ECLIA, and novel immunochromatography assay—ICA/rapid PSA) in the same blood sample. Two blood samples were drawn; first before DRE and the second 30–40 min after DRE. The effect of DRE on PSA levels and its impact on clinical decision-making for individual patients were evaluated based on different biopsy trigger cutoffs.
Results
ECLIA-PSA was measured in 74 participants both pre- and 37 ± 5 min post-DRE, mean age 57.2 ± 8.3 years, and mean prostate volume 33.6 (20–80) cm
3
. Both total and free ECLIA-PSA increased significantly after DRE (mean increase of 0.47 and 0.26 ng/ml, respectively, both
p
< 0.001). Different internationally accepted biopsy triggers were reached after DRE only: 5 total PSA > 3 ng/ml, 13 increase > 0.75 ng/ml, 3 PSA density > 0.15, and 1 free/total PSA < 0.18. On two occasions, patients were pushed away from biopsy trigger after DRE due to free/total PSA > 0.18. ICA-PSA was detectable (> 2.0 ng/ml) in 5 of 45 measured samples (11%) before DRE and 13/45 (29%) after DRE,
p
= 0.0316. Four among five detectable ICA-PSA tests increased after DRE.
Conclusion
Performing DRE immediately before PSA measurement might change the clinical decision-making on a significant number of occasions (roughly 1 in 3); even though the mean increase (0.47 ng/ml) looks deceivingly small. Further studies are required that include gold standard tests (biopsy, or imaging).</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><doi>10.1007/s11255-022-03283-5</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-2092-414X</orcidid></addata></record> |
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| subjects | Biopsy Chemiluminescence Clinical decision making Decision making Medicine Medicine & Public Health Nephrology Patients Prostate Prostate cancer Rectum Urology Urology - Original Paper |
| title | Digital rectal examination impact on PSA derivatives and prostate biopsy triggers: a contemporary study |
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