2864f6848630e1c3ef0faeb6c4a9761b pmc_11595409.pdf 3aeb7d085b159057fcb083cf0806d7a9813fbd91 pmc_11595409.pdf 9b1ab5730b9f645b93d7f912830305b6d7d0ca09e9b8fdc99a021438e84c633e pmc_11595409.pdf Title: The Role of Digital Rectal Examination for Early Detection of Significant Prostate Cancer in the Era of Magnetic Resonance Imaging Subject: The role of digital rectal examination (DRE) in the early detection of significant prostate cancer (PCa) is being questioned in the era of magnetic resonance imaging (MRI). However, some men with suspected PCa may still be identified solely through DRE, even with low serum prostate-specific antigen (PSA) levels. Additionally, most predictive models designed to improve significant PCa diagnostic pathways incorporate DRE findings. We assessed the role of DRE among 5005 men with serum PSA levels > 3.0 ng/mL and/or suspicious DRE findings, who underwent pre-biopsy MRI and targeted and/or systematic biopsies, as part of the significant PCa opportunistic screening program in Catalonia (Spain) between 2016 and 2023. Significant PCa, defined as grade group > 2, was detected in 2097 men (41.9%). Suspicion of PCa was based solely on DRE in 206 cases (4.1%) with significant PCa detected in 50 of them (2.4%). Two pathways using the Barcelona predictive models, before and after MRI, with and without DRE findings showed specificities of 52.8 and 38.7%, respectively (p < 0.001), after fixing sensitivity at 90%. Prostate biopsy was avoided in 35.1 and 26.7%, respectively (p < 0.001), while its efficacy increased from 52.8 to 58%. We conclude that DRE improved the effectiveness of an opportunistic significant PCa-screening program. Keywords: prostate cancer; early detection; digital rectal examination Author: Juan Morote, Nahuel Paesano, Natàlia Picola, Jesús Muñoz-Rodriguez, Xavier Ruiz-Plazas, Marta V. Muñoz-Rivero, Ana Celma, Gemma García-de Manuel, Berta Miró, José M. Abascal, Pol Servian, Olga Méndez and Enrique Trilla Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed Oct 23 13:30:16 2024 CEST ModDate: Wed Oct 23 13:34:15 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 854407 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- QGYAWM+SFRM0800 Type 1 Custom yes yes yes 10 0 SEIQES+VnURWPalladioL-Bold Type 1 Custom yes yes yes 16 0 RSGPLG+URWPalladioL-Bold Type 1 Custom yes yes yes 22 0 UIGCYC+URWPalladioL-Roma Type 1 Custom yes yes yes 28 0 DBGDJR+URWPalladioL-Ital Type 1 Custom yes yes yes 33 0 QKAYUX+VnURWPalladioL Type 1 Custom yes yes yes 38 0 PJCGLK+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 55 0 WABLSD+SFRM1000 Type 1 Custom yes yes yes 75 0 ICRTVP+CMSY10 Type 1 Builtin yes yes yes 83 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 88 0 VNIGQI+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 98 0 VAKGQI+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 106 0 VVGBQI+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 114 0 PMJRKU+PalatinoLinotype-Italic TrueType WinAnsi yes yes yes 122 0 EYYIMQ+PalatinoLinotype-Bold TrueType WinAnsi yes yes yes 126 0 AATKIY+PalatinoLinotype-Roman TrueType WinAnsi yes yes yes 130 0 VNIGQI+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 139 0 VAKGQI+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 147 0 VVGBQI+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 155 0 PMJRKU+PalatinoLinotype-Italic TrueType WinAnsi yes yes yes 163 0 EYYIMQ+PalatinoLinotype-Bold TrueType WinAnsi yes yes yes 167 0 AATKIY+PalatinoLinotype-Roman TrueType WinAnsi yes yes yes 171 0 BOLMEN+SFRM0900 Type 1 Custom yes yes yes 181 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-12-14 02:46:34 CET RepresentationInformation: pmc_11595409.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-12-04 02:21:19 CET Size: 854407 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 347 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Design, Setting, and Participants Destination: subsection.2.1 Item: Title: Data Analysis Destination: subsection.2.2 Item: Title: Significant Prostate Cancer Diagnostic Pathway Destination: subsection.2.3 Item: Title: Variables in the Study Destination: subsection.2.4 Item: Title: Statistical Analysis Destination: subsection.2.5 Item: Title: Results Destination: section.3 Children: Item: Title: Characteristics of Study Population Destination: subsection.3.1 Item: Title: Independence of DRE for Significant Prostate Cancer Detection Destination: subsection.3.2 Item: Title: Significant Prostate Cancer Detection Solely Through Suspicious DRE Destination: subsection.3.3 Item: Title: Effect of DRE Findings for Improving the Efficacy of the Barcelona Diagnostic Pathway Destination: subsection.3.4 Item: Title: Aggressiveness of Significant PCa Detected in Men Suspected of Having PCa Solely Identified with DRE Destination: subsection.3.5 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: The Role of Digital Rectal Examination for Early Detection of Significant Prostate Cancer in the Era of Magnetic Resonance Imaging Author: Juan Morote, Nahuel Paesano, Natàlia Picola, Jesús Muñoz-Rodriguez, Xavier Ruiz-Plazas, Marta V. Muñoz-Rivero, Ana Celma, Gemma García-de Manuel, Berta Miró, José M. Abascal, Pol Servian, Olga Méndez and Enrique Trilla Subject: The role of digital rectal examination (DRE) in the early detection of significant prostate cancer (PCa) is being questioned in the era of magnetic resonance imaging (MRI). However, some men with suspected PCa may still be identified solely through DRE, even with low serum prostate-specific antigen (PSA) levels. Additionally, most predictive models designed to improve significant PCa diagnostic pathways incorporate DRE findings. We assessed the role of DRE among 5005 men with serum PSA levels > 3.0 ng/mL and/or suspicious DRE findings, who underwent pre-biopsy MRI and targeted and/or systematic biopsies, as part of the significant PCa opportunistic screening program in Catalonia (Spain) between 2016 and 2023. Significant PCa, defined as grade group > 2, was detected in 2097 men (41.9%). Suspicion of PCa was based solely on DRE in 206 cases (4.1%) with significant PCa detected in 50 of them (2.4%). Two pathways using the Barcelona predictive models, before and after MRI, with and without DRE findings showed specificities of 52.8 and 38.7%, respectively (p < 0.001), after fixing sensitivity at 90%. Prostate biopsy was avoided in 35.1 and 26.7%, respectively (p < 0.001), while its efficacy increased from 52.8 to 58%. We conclude that DRE improved the effectiveness of an opportunistic significant PCa-screening program. 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