Article Figures & Data
Figures
- Figure 1
PRISMA flowchart for the selection of articles.
CINAHL = Cumulative Index to Nursing and Allied Health Literature; DARE = Database of Abstracts of Reviews of Effects; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Tables
Study, Year Country Design Patients Screened, No. Patients Undergoing Biopsy, No. Age Range, y Indication(s) for Biopsy Al-Azab et al,16 2007 Canada Retrospective chart review 1,796 1,796 40–93 Elevated age-specific PSA level or abnormal DRE findings Brett,17 1998 Australia Prospective cohort study 211 11 50–79 Abnormal DRE findings or PSA level ≥4.1 ng/mL Crawford et al,18 1999 United States Retrospective chart review 142,111 4,160 40–79 Abnormal DRE findings or PSA level ≥4 ng/mL Elliott et al,19 2008 United States Retrospective review of prospectively collected data 1,564 1,564 N/A Abnormal DRE findings and/or PSA level ≥4 ng/mL Faria et al,20 2012 Brazil Prospective cohort study 17,571 1,647 45–98 Abnormal DRE findings and/or PSA level ≥4 ng/mL; and starting Nov 2004, PSA 2.5–3.9 ng/mL and % free PSA level ≤15 Kirby et al,21 1994 United Kingdom Prospective cohort study 568 29 55–70 Abnormal DRE findings or PSA level >4 ng/mL Pederson et al,22 1990 Sweden Prospective cohort study 1,163 34 50–69 Abnormal DRE findings DRE=digital rectal examination; N/A=not available; PSA=prostate-specific antigen.
Risk of Bias Applicability Concerns Study, Year Patient Selection Index Test Reference Standard Flow and Timing Patient Selection Index Test Reference Standard Al-Azab et al,16 2007 High High Low High Unclear Unclear Low Brett,17 1998 Unclear Low Low High Low Low Low Crawford et al,18 1999 Unclear High Low High Low Unclear Low Elliott et al,19 2008 Unclear Low Low High Unclear Unclear Low Faria et al,20 2012 Unclear High Low High Low Unclear Low Kirby et al,21 1994 Low Low Low High Low Low Low Pederson et al,22 1990 Low Low Low High Low Low Low QUADAS-2 = Quality Assessment of Diagnostic Accuracy Studies 2.
Outcomes No. of Studies (No. of Patients) Study Design Domain Risk of Bias Indirectness Inconsistency Imprecision Publication Bias Test of Accuracy Sensitivity and specificitya True positive and false negative 6 (3,304) Cross-sectional (cohort type accuracy study) Seriousb Not serious Very seriousc Very seriousd None Very low True negative and false positive 4 (5,877) Cross-sectional (cohort type accuracy study) Seriousb Not serious Very seriouse Very seriousd None Very low PPV and NPVf True positive and false positive 6 (4,581) Cross-sectional (cohort type accuracy study) Seriousb Not serious Very seriousg Very seriousd None Very low True negative and false negative 4 (4,634) Cross-sectional (cohort type accuracy study) Seriousb Not serious Very serioush Very seriousd None Very low GRADE = Grades of Recommendation Assessment, Development, and Evaluation; NPV = negative predictive value; PPV = positive predictive value.
↵a Sensitivity = 0.51 (95% CI, 0.36–0.67); specificity = 0.59 (95% CI, 0.41–0.76).
↵b According to Quality Assessment of Diagnostic Accuracy Studies 2 tool, all studies included in this meta-analysis were deemed to have significant risk of bias concerns.
↵c Unexplained heterogeneity between studies (I2=98.4%).
↵d The confidence interval is a range that, if the true value were to lie within it, would result in different clinical decisions depending on where it fell.
↵e Unexplained heterogeneity between studies (I2=99.4%).
↵f PPV = 0.41 (95% CI, 0.31–0.52); NPV = 0.64 (95% CI, 0.58–0.70).
↵g Unexplained heterogeneity between studies (I2= 97.2%).
↵h Unexplained heterogeneity between studies (I2= 95.0%).
- Table 4
Summary Findings and Meta-Analysis of Diagnostic Accuracy of DRE for Prostate Cancer Screening in Primary Care Settings
Study, Year Sensitivity Specificity PPV NPV Al-Azab et al,16 2007 0.50 0.61 0.49 0.62 Brett,17 1998 0.67 N/A N/A N/A Crawford et al,18 1999 0.65 0.37 0.29 0.72 Elliott et al,19 2008 0.65 0.65 0.52 0.64 Faria et al,20 2012 0.24 0.72 0.36 0.59 Kirby et al,21 1994 0.73 N/A N/A N/A Pederson et al,22 1990 N/A N/A 0.26 N/A Pooled analysisa Estimate (95% CI) 0.51 (0.36–0.67) 0.59 (0.41–0.76) 0.41 (0.31–0.52) 0.64 (0.58–0.70) Heterogeneity: I2, % 98.4 99.4 97.2 95.0 DRE = digital rectal examination; NPV = negative predictive value; N/A = not available; PPV = positive predictive value.
↵a Pooled analysis of data from 6 studies of 3,304 patients total for sensitivity; 4 studies of 5,877 patients total for specificity; 6 studies of 4,581 patients total for positive predictive value; and 4 studies of 4,634 patients total for negative predictive value.
Supplemental Appendixes
Supplemental Appendixes
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The Article in Brief
Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis
Jason Profetto , and colleagues
Background Although digital rectal examination is commonly used to screen for prostate cancer, there is limited data to support its use in primary care. This analysis of existing research aims to evaluate the diagnostic accuracy of the digital rectal exam in screening for prostate cancer in primary care settings.
What This Study Found There is limited data to support the effectiveness of digital rectal examination in primary care. The study found that the quality of available evidence was very low and that existing studies were at risk of bias. Pooled sensitivity of the digital rectal exam among primary care physicians was 0.51 and pooled specificity was 0.59.
Implications
- Given the considerable lack of evidence supporting its efficacy, the authors recommend against routinely performing digital rectal exams to screen for prostate cancer in the primary care setting.
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