Evidence map›Paper›PMID 32223879›Full record

ArticleCanadian Urological Association journal = Journal de l'Association des urologues du Canada2020

Utility of digital rectal examination in a population with prostate cancer treated with active surveillance.

Jaime O Herrera-Caceres, Marian S Wettstein, Hanan Goldberg, Ants Toi, Thenappan Chandrasekar, Dixon T S Woon, Ardalan E Ahmad, Noelia Sanmamed-Salgado, Omar Alhunaidi, Khaled Ajib and 4 more

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Article in Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.6field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 4 institutions in 2 countries.

Jaime O Herrera-CaceresDivision of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, ON, Canada.
Marian S WettsteinDivision of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, ON, Canada.
Hanan GoldbergDivision of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, ON, Canada.
Ants ToiDepartment of Medical Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
Thenappan ChandrasekarDepartment of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States.
Dixon T S WoonDivision of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, ON, Canada.
Ardalan E AhmadDivision of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, ON, Canada.
Noelia Sanmamed-SalgadoDepartment of Radiation Oncology, University of Toronto and University Health Network, Toronto, ON, Canada.
Omar AlhunaidiDivision of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, ON, Canada.
Khaled AjibDivision of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, ON, Canada.
Gregory NasonDivision of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, ON, Canada.
Guan Hee TanDivision of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, ON, Canada.
Neil FleshnerDivision of Urology, Department of Surgical Oncology, University of Toronto and University Health Network, Toronto, ON, Canada.
Laurence KlotzDivision of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
University Health Network · CASunnybrook Health Science Centre · CAThomas Jefferson University · USUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionDigital rectal examination (DRE) is part of the clinical evaluation of men on active surveillance (AS). The purpose of the present study is to analyze the value of DRE as a predictor of upgrading in a population of men with prostate cancer (PCa) treated with AS.

methodsWe used the prostate biopsy (PBx) database from an academic center, including PBx from 2006-2018, and identified 2029 confirmatory biopsies (CxPBx) of men treated with AS, of which 726 men had both diagnostic (initial) and CxPBx information available. We did a descriptive analysis and evaluated sensitivity, specificity, and predictive values of DRE for the detection of clinically significant PCa (csPCa). Multivariable regression analysis was done to identify predictors of csPCa. The primary outcome was to evaluate DRE as a predictor of the presence of csPCa at CxPBx.

resultsAmong the 2029 patients with a CxPBx, 75% had PCa, and of these, 30.3% had upgrading to International Society of Urologic Pathologists (ISUP) grade ≥2. Thirteen percent of men had a suspicious DRE (done by their treating physician). Sensitivity, specificity, negative and positive predictive values of DRE to detect csPCa were best with a prostate-specific antigen (PSA) <4 ng/ml (27%, 88%, 31%, and 87%, respectively). A suspicious DRE at CxPBx, particularly if the DRE at diagnosis was negative, was a predictor of csPCa (odds ratio [OR] 2.34, p=0.038). The main limitation of our study is the retrospective design and the lack of magnetic resonance imaging.

conclusionsWe believe DRE should still be used as part of AS and can predict the presence of csPCa, even with low PSA values. A suspicious nodule on DRE represents a higher risk of upgrading and should prompt further assessment.

Identifiers

PMID32223879
PMCPMC7492034
OpenAlexW3013353403

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.