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Concept: Rectal examination


BACKGROUND: A small pre-test study was conducted to ascertain potential harm and anxiety associated with distributing information about possible cancer treatment options at the time of biopsy, prior to knowledge about a definitive cancer diagnosis. Priming men about the availability of multiple options before they have a confirmed diagnosis may be an opportunity to engage patients in more informed decision-making. METHODS: Men with an elevated PSA test or suspicious Digital Rectal Examination (DRE) who were referred to a urology clinic for a biopsy were randomized to receive either the clinic’s usual care (UC) biopsy instruction sheet (n = 11) or a pre-biopsy educational (ED) packet containing the biopsy instruction sheet along with a booklet about the biopsy procedure and a prostate cancer treatment decision aid originally written for newly diagnosed men that described in detail possible treatment options (n = 18). RESULTS: A total of 62% of men who were approached agreed to be randomized, and 83% of the ED group confirmed they used the materials. Anxiety scores were similar for both groups while awaiting the biopsy procedure, with anxiety scores trending lower in the ED group: 41.2 on a prostate-specific anxiety instrument compared to 51.7 in the UC group (p = 0.13). ED participants reported better overall quality of life while awaiting biopsy compared to the UC group (76.4 vs. 48.5, p = 0.01). The small number of men in the ED group who went on to be diagnosed with cancer reported being better informed about the risks and side effects of each option compared to men diagnosed with cancer in the UC group (p = 0.07). In qualitative discussions, men generally reported they found the pre-biopsy materials to be helpful and indicated having information about possible treatment options reduced their anxiety. However, 2 of 18 men reported they did not want to think about treatment options until after they knew their biopsy results. CONCLUSIONS: In this small sample offering pre-biopsy education about potential treatment options was generally well received by patients, appeared to be beneficial to men who went on to be diagnosed, and did not appear to increase anxiety unnecessarily among those who had a negative biopsy.

Concepts: Cancer, Metastasis, Biopsy, Prostate cancer, Screening, Benign prostatic hyperplasia, Rectal examination, Prostate-specific antigen


Colonoscopy is a widely used diagnostic and therapeutic modality with a relatively low morbidity. However, given the large volume of procedures performed, awareness of the infrequent complications is essential. Perforation is an established complication of colonoscopy, and can range from 0.2%-3% depending on the series, population and modality of colonoscopy. Acute appendicitis after colonoscopy is an extremely rare event, and a cause-effect relationship between the colonoscopy and the appendicitis is not well documented. In addition, awareness of this condition can aid in prompt diagnosis. Relatively mild symptoms and exclusion of bowel perforation by contrast studies do not exclude appendicitis from the differential diagnosis for post-colonoscopy pain. In addition to the difficult diagnosis inherent to postcolonoscopy appendicitis, treatment strategies have varied greatly. This paper reviews these approaches. We also expand upon prior articles by giving guidance for the role of nonoperative management in these patients. This case and review of the literature will help to create awareness about this complication, and guide optimal treatment of pericolonoscopy appendicitis.

Concepts: Medical terms, Diagnosis, Medical emergencies, Medical diagnosis, Differential diagnosis, Peritonitis, Rectal examination, Vermiform appendix


Although the digital rectal examination (DRE) is commonly performed to screen for prostate cancer, there is limited data to support its use in primary care. This review and meta-analysis aims to evaluate the diagnostic accuracy of DRE in screening for prostate cancer in primary care settings.

Concepts: Cancer, Prostate cancer, Screening, Benign prostatic hyperplasia, Overdiagnosis, Rectal examination, Prostate-specific antigen, Prostate cancer screening


BACKGROUND: We compared urinary prostate cancer antigen 3 (PCA3), transmembrane protease, serine 2 (TMPRSS2):v-ets erythroblastosis virus E26 oncogene homolog (avian) (ERG) gene fusion (T2:ERG), and the serum [-2]proprostate-specific antigen ([-2]proPSA)-based prostate health index (Phi) for predicting biopsy outcome.METHODS: Serum samples and first-catch urine samples were collected after digital rectal examination (DRE) from consented outpatients with PSA 0.5-20 μg/L who were scheduled for prostate biopsy. The PCA3 score (PROGENSA PCA3, Hologic Gen-Probe) and T2:ERG score (Hologic Gen-Probe) were determined. Measurements of serum PSA, free PSA, and [-2]proPSA (Beckman Coulter) were performed, and the percentages of free PSA (%fPSA) and Phi ([-2]proPSA/%fPSA × ∣PSA) were determined.RESULTS: Of 246 enrolled men, prostate cancer (PCa) was diagnosed in 110 (45%) and there was no evidence of malignancy (NEM) in 136 (55%). A first set of biopsies was performed in 136 (55%) of all men, and 110 (45%) had ≥1 repeat biopsies. PCA3, Phi, and T2:ERG differed significantly between men with PCa and NEM, and these markers showed the largest areas under the ROC curve (AUCs) (0.74, 0.68, and 0.63, respectively). PCA3 had the largest AUC of all parameters, albeit not statistically different from Phi. Phi showed somewhat lower specificities than PCA3 at 90% sensitivity. Combination of both markers enhanced diagnostic power with modest AUC gains of 0.01-0.04. Although PCA3 had the highest AUC in the repeat-biopsy cohort, the highest AUC for Phi was observed in DRE-negative patients with PSA in the 2-10 μg/L range.CONCLUSIONS: PCA3 and Phi were superior to the other evaluated parameters but their combination gave only moderate enhancements in diagnostic accuracy for PCa at first or repeat prostate biopsy.

Concepts: Cancer, Biopsy, Prostate cancer, Benign prostatic hyperplasia, Early prostate cancer antigen-2, Beckman Coulter, Rectal examination, PCA3


In 2012 the US Preventive Services Task Force released recommendations against prostate specific antigen (PSA) based screening for prostate cancer, but did not fully address screening via digital rectal exam (DRE). As such, many practitioners continue to perform DRE in attempts to identify men with clinically significant prostate cancer (CSPC). This study seeks to determine the value of DRE in detecting CSPC in the era of PSA-based screening.

Concepts: Prostate cancer, Colonoscopy, Benign prostatic hyperplasia, Rectal examination


The association between vitamin D and prostate biopsy outcomes has not been evaluated. We examine serum vitamin D levels with prostate biopsy results in men with an abnormal prostate-specific antigen and/or digital rectal examination.

Concepts: Vitamin D, Cancer, Prostate cancer, Colonoscopy, Vitamins, Benign prostatic hyperplasia, Rectal examination


Extract: Prostate cancer (PCa) is the most commonly diagnosed malignancy among men living in Western countries and a major cause of cancer-related deaths. Biopsy-based diagnosis of PCa is usually undertaken following an elevated serum prostate specific antigen (PSA) measurement and/or abnormal digital rectal examination (DRE). The deficiencies of serum PSA as a biomarker have been well documented (Roobol and Carlsson 2013). While it is highly specific for tissue of prostatic origin, PSA is not cancer-specific, resulting in many unnecessary biopsies of benign disease. Moreover, PSA screening has resulted in substantial over-diagnosis and over-treatment of indolent tumours without having a significant effect on prostate cancer mortality (Schroder, et al. 2009). Biomarkers that could identify patients with clinically significant PCa would be ideal but are currently lacking …

Concepts: Cancer, Prostate cancer, Screening, Benign prostatic hyperplasia, Prostate, Rectal examination, Prostate-specific antigen, Prostate cancer screening


Although digital rectal examination is an established part of physical examination in patients with acute gastrointestinal bleeding, clinicians are reluctant to perform rectal examination. We intended to assess if rectal examination affects the clinical management decision in these patients.

Concepts: Medicine, Hospital, Therapy, Colonoscopy, Gastroenterology, Physical examination, Rectal examination, Gastrointestinal bleeding


Guidelines from the National Cancer Care Network (NCCN) advocate digital rectal examination (DRE) screening only in men with elevated prostate specific antigen (PSA). We sought to investigate the effect of PSA on the association between DRE and clinically significant prostate cancer (CSPC) in a large, US cohort.

Concepts: Cancer, Metastasis, Prostate cancer, Screening, Benign prostatic hyperplasia, Rectal examination, Prostate-specific antigen, Prostate cancer screening


The Advanced Trauma Life Support Manual (8th ed.) recommend a digital rectal examination (DRE) as part of the initial evaluation of all trauma patients. A “high-riding” or “nonpalpable” prostate is a contraindication to urethral catheterization and an indication for urethrography. However, there are no published guidelines on, definitions of, or predictive values for high riding. Moreover, prostate evaluation can be difficult in the supine/trauma position.

Concepts: Definition, Colonoscopy, Value, Benign prostatic hyperplasia, Physical trauma, Rectal examination, Integrity