The study
A retrospective study of a cohort of Irish men (in a tertiary referral centre) who had a prostate biopsy despite a normal PSA level aimed to evaluate the role of PR examination to diagnose prostate cancer in patients with a normal PSA.
The findings
1 Mortality from prostate cancer was 50-70% less in patients who had a PR examination done in the 10 years preceding the diagnosis.
2 A significant number of men who had a positive PR examination and a normal PSA were diagnosed with prostate cancer.
3 PR examination had a sensitivity of 81% and a concordance of 76% for prostate cancer.
4 In one arm of the study, it was found that rectal examination alone detected 55% of prostate cancers.
5 A significant number of patients with high grade cancer would not have been referred and investigated on the basis of PR examination alone.
What does it mean for GPs?
PR examination is an vital part of the assessment for prostate cancer.
GPs should strongly consider referring patients with an abnormal PR examination to be investigated for prostate cancer, even with a normal PSA.
The paper
Dr Hamed Khan is a GP in the emergency department of St George’s, London and a clinical lecturer. He tweets as @drhamedkhan.
