An abnormal digital rectal examination is an independent predictor of Gleason ≥7 prostate cancer in men undergoing initial prostate biopsy: A prospective study of 790 men

OBJECTIVE: To evaluate our experience with a referral population of 790 patients undergoing initial prostate biopsy in the prostate-specific antigen (PSA) era, to assess the role of a digital rectal examination (DRE) in predicting the outcome of prostate needle biopsy (PNB) and to evaluate if DRE findings were associated with cancer grade. PATIENTS AND METHODS: We analysed 790 consecutive men who had an initial PNB from September 1999 to July 2005 by one urologist (C.P.). All data were collected in a prospective database. Multivariate logistic regression analysis was used to determine the relationship between an abnormal DRE and the presence of cancer and cancer grade on PNB. RESULTS: An abnormal DRE was an independent predictor for prostate cancer on multivariate analysis (odds ratio 2.18, 95% confidence interval 1.53-3.10, P < 0.001). In all patients biopsied, an abnormal DRE was associated with a Gleason sum of ≥ 7 on multivariate analysis (odds ratio 3.39, 2.07-5.53, P = 0.001). CONCLUSION: A DRE is a useful and important tool to use when assessing patients for a PNB. An abnormal DRE independently predicted high-grade disease in these men. These results might have important implications in the prediction of men with other than indolent prostate cancer.