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document
The interobserver variability of digital rectal examination in a large randomized trial for the screening of prostate cancer . BACKGROUND To analyze to what extent the percentage of suspicious digital rectal examination ( DRE ) findings vary between examiners and to what extent the percentage of prostate cancers ( PCs ) detected in men with these suspicious findings varies between examiners . METHODS In the first screening round of the European Randomized study of Screening for PC ( ERSPC ) Rotterdam , 7,280 men underwent a PSA-determination and DRE of whom 2,102 underwent prostate biopsy ( biopsy indication PSA > or = 4.0 ng/ml and/or suspicious DRE and/or TRUS ) . Descriptive statistics of DRE-outcome per PSA-range were used to determine the observer variability of six examiners . Because this analysis did not correct properly for other predictors of a suspicious DRE ( PSA-level , biopsy indication , TRUS-outcome , prostate volume and age ) , a logistic regression analysis controlling for these explanatory variables was performed as well . RESULTS In 2,102 men biopsied , 443 PCs were detected ( PPV = 21 % ) . For all PSA levels the percentage suspicious DRE varied between examiners from 4 % to 28 % and percentage PC detected in men with a suspicious DRE varied from 18 % to 36 % . Logistic regression analysis showed that three of six examiners considered DRE significantly more often abnormal than others ( ORs 3.48 , 2.80 , 2.47 , P < 0.001 ) . For all examiners the odds to have PC was statistically significantly higher in case of a suspicious DRE ( ORs 2.21-5.96 , P < 0.05 ) . This increased chance to find PC was not significantly observer-dependent . CONCLUSIONS Three of six examiners considered DRE significantly more often suspicious than the others . However , under equal circumstances a suspicious DRE executed by each examiner increased the chance of the presence of PC similarly .
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Intervention_Physical
digital rectal examination
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Intervention_Physical
digital rectal examination ( DRE )
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Intervention_Physical
PSA-determination and DRE of whom 2,102 underwent prostate biopsy
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Intervention_Physical
DRE
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Intervention_Physical
DRE
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Outcome_Physical
Descriptive statistics of DRE-outcome per PSA-range
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Outcome_Physical
suspicious DRE ( PSA-level , biopsy indication , TRUS-outcome , prostate volume and age )
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Outcome_Physical
percentage suspicious DRE
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Outcome_Physical
percentage PC
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Outcome_Physical
DRE
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Outcome_Physical
PC
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Outcome_Physical
suspicious DRE
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Outcome_Physical
PC
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Outcome_Physical
DRE
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Outcome_Physical
DRE
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Outcome_Physical
PC
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Participant_Condition
to what extent the percentage of prostate cancers ( PCs ) detected in men with these suspicious findings varies between examiners .
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Participant_Sample-size
2,102
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Participant_Sample-size
2,102
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Participant_Sex
men
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Participant_Sample-size
443
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Participant_Sex
men with a
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Participant_Condition
suspicious DRE