Is there any role for DRE in modern prostate cancer diagnostics: results from a Multi-tertiary centre collaboration?
BAUS ePoster online library. Smekal M. 06/21/21; 318990; p1-2
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Martina Smekal
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Abstract
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Introduction
Prostate cancer (PCA) diagnostics involve multiparametric MRI and digital rectal examination (DRE). While the decision whether to proceed to biopsy is based primarily on MRI findings, PSA density (PSAD) and abnormal DREs also influence the decision-making process. South East London Cancer Alliance Guidelines utilise Prostate Imaging-Reporting And Data System (PI-RADS): PI-RADS 3-5 are routinely offered biopsies; PI-RADS 2 may also be offered biopsies if PSAD >0.12, DRE is abnormal or other risk factors are present.
Our objective is to assess the value of DREs in PCA diagnostics when MRI is normal.
Patients & Methods
Patients with normal MRI findings (PI-RADS 1-2) were selected from a multicentre database of prostate 2ww pathway patients (01/09/2019–30/06/2020). PCA detection in patients with abnormal DREs (abDRE) was compared to those with normal DREs (norDRE) using Fisher's exact test.
Results
569/1466 patients had normal MRI findings (median PSAD 0.11, 0.07-0.16). 66 patients proceeded to biopsy (median PSAD 0.18, 0.13-0.27). Results are summarised in Table 1.
Conclusions
Our data demonstrates that despite a normal MRI, PCA detection rate was 42%, with a 23% detection rate of csPCA. PCA detection rate in norDRE patients was equivalent to abDRE patients (40% vs 50%, p 0.338), as was csPCA detection rate (22% vs 25%, p 0.524). We recommend that prostate diagnostics can be undertaken safely in the remote setting, without requiring face-to-face consultations for DRE, if biopsies are routinely offered in PI-RADS 2 with PSAD >0.12.
Prostate cancer (PCA) diagnostics involve multiparametric MRI and digital rectal examination (DRE). While the decision whether to proceed to biopsy is based primarily on MRI findings, PSA density (PSAD) and abnormal DREs also influence the decision-making process. South East London Cancer Alliance Guidelines utilise Prostate Imaging-Reporting And Data System (PI-RADS): PI-RADS 3-5 are routinely offered biopsies; PI-RADS 2 may also be offered biopsies if PSAD >0.12, DRE is abnormal or other risk factors are present.
Our objective is to assess the value of DREs in PCA diagnostics when MRI is normal.
Patients & Methods
Patients with normal MRI findings (PI-RADS 1-2) were selected from a multicentre database of prostate 2ww pathway patients (01/09/2019–30/06/2020). PCA detection in patients with abnormal DREs (abDRE) was compared to those with normal DREs (norDRE) using Fisher's exact test.
Results
569/1466 patients had normal MRI findings (median PSAD 0.11, 0.07-0.16). 66 patients proceeded to biopsy (median PSAD 0.18, 0.13-0.27). Results are summarised in Table 1.
Conclusions
Our data demonstrates that despite a normal MRI, PCA detection rate was 42%, with a 23% detection rate of csPCA. PCA detection rate in norDRE patients was equivalent to abDRE patients (40% vs 50%, p 0.338), as was csPCA detection rate (22% vs 25%, p 0.524). We recommend that prostate diagnostics can be undertaken safely in the remote setting, without requiring face-to-face consultations for DRE, if biopsies are routinely offered in PI-RADS 2 with PSAD >0.12.
Introduction
Prostate cancer (PCA) diagnostics involve multiparametric MRI and digital rectal examination (DRE). While the decision whether to proceed to biopsy is based primarily on MRI findings, PSA density (PSAD) and abnormal DREs also influence the decision-making process. South East London Cancer Alliance Guidelines utilise Prostate Imaging-Reporting And Data System (PI-RADS): PI-RADS 3-5 are routinely offered biopsies; PI-RADS 2 may also be offered biopsies if PSAD >0.12, DRE is abnormal or other risk factors are present.
Our objective is to assess the value of DREs in PCA diagnostics when MRI is normal.
Patients & Methods
Patients with normal MRI findings (PI-RADS 1-2) were selected from a multicentre database of prostate 2ww pathway patients (01/09/2019–30/06/2020). PCA detection in patients with abnormal DREs (abDRE) was compared to those with normal DREs (norDRE) using Fisher's exact test.
Results
569/1466 patients had normal MRI findings (median PSAD 0.11, 0.07-0.16). 66 patients proceeded to biopsy (median PSAD 0.18, 0.13-0.27). Results are summarised in Table 1.
Conclusions
Our data demonstrates that despite a normal MRI, PCA detection rate was 42%, with a 23% detection rate of csPCA. PCA detection rate in norDRE patients was equivalent to abDRE patients (40% vs 50%, p 0.338), as was csPCA detection rate (22% vs 25%, p 0.524). We recommend that prostate diagnostics can be undertaken safely in the remote setting, without requiring face-to-face consultations for DRE, if biopsies are routinely offered in PI-RADS 2 with PSAD >0.12.
Prostate cancer (PCA) diagnostics involve multiparametric MRI and digital rectal examination (DRE). While the decision whether to proceed to biopsy is based primarily on MRI findings, PSA density (PSAD) and abnormal DREs also influence the decision-making process. South East London Cancer Alliance Guidelines utilise Prostate Imaging-Reporting And Data System (PI-RADS): PI-RADS 3-5 are routinely offered biopsies; PI-RADS 2 may also be offered biopsies if PSAD >0.12, DRE is abnormal or other risk factors are present.
Our objective is to assess the value of DREs in PCA diagnostics when MRI is normal.
Patients & Methods
Patients with normal MRI findings (PI-RADS 1-2) were selected from a multicentre database of prostate 2ww pathway patients (01/09/2019–30/06/2020). PCA detection in patients with abnormal DREs (abDRE) was compared to those with normal DREs (norDRE) using Fisher's exact test.
Results
569/1466 patients had normal MRI findings (median PSAD 0.11, 0.07-0.16). 66 patients proceeded to biopsy (median PSAD 0.18, 0.13-0.27). Results are summarised in Table 1.
Conclusions
Our data demonstrates that despite a normal MRI, PCA detection rate was 42%, with a 23% detection rate of csPCA. PCA detection rate in norDRE patients was equivalent to abDRE patients (40% vs 50%, p 0.338), as was csPCA detection rate (22% vs 25%, p 0.524). We recommend that prostate diagnostics can be undertaken safely in the remote setting, without requiring face-to-face consultations for DRE, if biopsies are routinely offered in PI-RADS 2 with PSAD >0.12.
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