MAAUA: MAAUA 68th Annual Meeting Abstracts - Diagnostic Yield Of Prostate Needle Biopsies Performed In Men With An Abnormal Digital Rectal Exam

MAAUA 68th Annual Meeting Abstracts

Diagnostic Yield Of Prostate Needle Biopsies Performed In Men With An Abnormal Digital Rectal Exam
Vanessa L Elliott, *Ricardo Palmerola, *Paul Smith, Carl T Reese, Frank B Mahon, Ross M Decter, Lewis E Harpster, Jay D Raman
Penn State Hershey Medical Center, Hershey, PA

Introduction:
Elevated prostate specific antigen (PSA) and abnormal digital rectal examination (DRE) are indications for prostate needle biopsy (PNB). Series using older PSA thresholds suggest that 25% of men with a normal PSA and abnormal DRE have prostate cancer (PCa). We evaluated a contemporary cohort to determine the detection rate.
Materials & Methods:
The charts of 900 men who underwent PNB were reviewed. Patients with prior or extended PNB were excluded. PSA was deemed normal/abnormal by age-specific cutoffs. A normal prostate was smooth, age-appropriate, or enlarged. An abnormal DRE was nodular, indurated, or asymmetric.
Results:
Of 814 men, 54% had a normal and 46% an abnormal DRE. Patients were stratified by PSA and DRE (Table 1). 306 of 814 men (38%) had PCa; 80% had an abnormal PSA, 57% an abnormal DRE, and 41% both. The rate of PCa with an isolated abnormal DRE was 13% increasing to 34% with a concomitant abnormal PSA. No difference existed between DRE abnormalities (p=0.96). An abnormal DRE had a sensitivity of 57%, specificity of 60%, and positive predictive value (PPV) of 46% for PCa. For men with a normal PSA, the sensitivity of an abnormal DRE increased to 79%, while specificity and PPV decreased to 29%
Conclusions:
13% of men with isolated DRE abnormalities had PCa. This information may aid in patient counseling and determination of biopsy thresholds.
Table 1: Distribution of all 814 study patients stratified by PSA and DRE status
Normal PSA
No. (%) Abnormal PSA
No. (%)
Abnormal DRE 164 (20) 206 (26)
Normal DRE 61 (8) 375 (46)

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