Digital Rectal Exam Remains Key in Men With Low PSA

Digital rectal exam findings are suspicious for cancer in many with PSA less than 2.5

21 june 2009-- Due to the number of men who may have aggressive prostate cancers despite a low prostate specific antigen (PSA), digital rectal exams (DREs) remain important in detecting early cancer, according to research published in the June issue of the Journal of Urology.

Joshua J. Meeks, M.D., of the Northwestern Feinberg School of Medicine in Chicago, and colleagues analyzed data from 77 patients who underwent radical retropubic prostatectomy and had a preoperative PSA less than 2.5 ng/ml.

The researchers found that in 66 percent of these men with low PSA, DRE findings were suspicious for cancer. The Gleason sum was 7 or higher in 10.4 percent of the men at biopsy and 26 percent of the men at surgery. Nine percent of patients had extracapsular tumor extension, and nearly 7.8 percent had positive surgical margins. The authors further note that mean tumor volume was significantly higher in men with a suspicious DRE compared to a normal exam (3.3 versus 1.7 cc).

"This study confirms that if we hope to detect some of these cancers without even an intermediate PSA increase, DRE can be a potent tool to detect clinically significant cancers in referral populations. The authors reported that adverse pathological features were observed significantly more frequently in patients with an abnormal DRE than in those with a normal DRE," writes the author of an accompanying editorial.

A study co-author reported a relationship with Beckman Coulter Inc., which supported the study, and deCODE Genetics.

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