Digital rectal examination impact on PSA derivatives and prostate biopsy triggers: a contemporary study.

Autor: da Silva Junior MM; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil.; Paulínia Municipal Hospital, Paulínia, SP, Brazil., Capibaribe DM; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil.; Paulínia Municipal Hospital, Paulínia, SP, Brazil., Avilez ND; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil.; Paulínia Municipal Hospital, Paulínia, SP, Brazil., Jalalizadeh M; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil.; Paulínia Municipal Hospital, Paulínia, SP, Brazil., Dias LB; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil.; Paulínia Municipal Hospital, Paulínia, SP, Brazil., Laranja WW; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil.; Paulínia Municipal Hospital, Paulínia, SP, Brazil., Guimarães F; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil.; Paulínia Municipal Hospital, Paulínia, SP, Brazil., Simões FA; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil.; Paulínia Municipal Hospital, Paulínia, SP, Brazil., Alonso JCC; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil.; Paulínia Municipal Hospital, Paulínia, SP, Brazil., Rejowski RF; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil.; Paulínia Municipal Hospital, Paulínia, SP, Brazil., Cintra A; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil.; Paulínia Municipal Hospital, Paulínia, SP, Brazil., Reis LO; UroScience, Faculty of Medical Sciences, State University of Campinas, UNICAMP, Campinas, SP, Brazil. reisleo.l@gmail.com.; Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil. reisleo.l@gmail.com.; Paulínia Municipal Hospital, Paulínia, SP, Brazil. reisleo.l@gmail.com.
Jazyk: angličtina
Zdroj: International urology and nephrology [Int Urol Nephrol] 2022 Sep; Vol. 54 (9), pp. 2117-2123. Date of Electronic Publication: 2022 Jul 05.
DOI: 10.1007/s11255-022-03283-5
Abstrakt: 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).
(© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)
Databáze: MEDLINE
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