Prostate cancer screening in Portugal: prevalence and perception of potential benefits and adverse effects.

INTRODUCTION: Opportunistic screening for prostate cancer has been widely used, though organized programs are not recommended. We aimed to estimate the prevalence of prostate cancer screening and the perception of potential benefits and harms of screening, among the Portuguese general population. METHODS: A representative sample of Portuguese-speaking inhabitants in mainland Portugal was selected, using a stratified probabilistic sampling procedure; men above 40 were considered for analysis (n = 414). Data on sociodemographic characteristics, lifetime use and usual frequency of prostate cancer screening (prostate-specific antigen test or digital rectal examination) and perception of potential benefits and adverse effects of cancer screening were assessed using face-to-face interviews, by structured questionnaire. RESULTS: The proportion of participants who reported having been submitted to prostate cancer screening at least once in their lifetime was 44.2% (95% confidence interval: 37.5-51.0; 13.8% only digital rectal examination, 12.2% only prostate-specific antigen test, and 18.2% digital rectal examination and prostate-specific antigen test). As potential benefits of cancer screening, the options "knowledge of not having the disease", "earlier detection" and "more effective treatment" were selected by 55.8%, 12.9% and 31.3% of the participants, respectively. Regarding potential adverse effects, the most and least frequently identified were 'anxiety while waiting for the results' (55.1%) and 'false negatives' (38.0%), respectively. CONCLUSIONS: Almost half of the men between 40 and 79 years old declared that they have been screened for prostate cancer. Nearly one-third of the participants considered that reassurance of a negative result was the main potential benefit of screening, whereas most failed to identify the most frequent adverse effects.

Prospective investigation of change in the prostate-specific antigens after various urologic procedures.

PURPOSE: Prostate-specific antigen (PSA) is the most important marker in the diagnosis and follow-up of patients with prostate cancer. The primary objective of this study was to evaluate the effect of various urologic procedures in prostatic area on serum free and total PSA levels. SUBJECTS AND METHODS: A series of 62 patients (8 after digital rectal examination [DRE], 12 after transrectal ultrasonography [TRUS], 11 after rigid cystoscopy, 13 after prostatic massage, 8 after TRUS-guided prostate biopsy, and 10 after transurethral resection of prostate [TURP]) were enrolled in the study. Blood samples were taken from each patient before procedure and at 10, 30, 60, and 120 minutes after procedures. RESULTS: Prostate massage, rigid cystoscopy, TURP, and TRUS-guided prostate biopsy caused statistically significant rise in total and free PSA levels in the serum. There was no significant increase in total and free PSA levels in the serum after DRE and TRUS. The mean differences were greater for free PSA level in the serum for TURP, TRUS-guided prostate biopsy, prostate massage, and rigid cystoscopy. CONCLUSION: Total and free PSA levels in the serum are altered by prostate massage, rigid cystoscopy, TRUS-guided prostate biopsy, and TURP. The PSA rises were related to the stimulation strength of the procedures. The total and free PSA levels were increased significantly from 10 minutes after procedures, except DRE and TRUS, and were increased to maximal level at 60 minutes after procedures.

Esclarecer o idoso sobre o exame digital retal diminui o desconforto na sua primeira realização? / Does clarifyng the digital rectal examination to the elderly reduce the discomfort in its first execution?

OBJETIVO: Verificar o grau de desconforto referido por homens idosos que realizam pela primeira vez o exame digital retal (EDR) na prevenção do câncer de próstata e o efeito de esclarecimentos prévios sobre essa queixa. MÉTODOS: Estudo prospectivo e aleatório em 120 homens, com idade de 60 a 80 anos, distribuídos em dois grupos: grupo A (consulta médica rotineira) e grupo B (consulta médica com intervenção educativa). No grupo B, os instrumentos de informação foram: palestra informal com esclarecimentos sobre EDR e câncer de próstata, visualização de maquete da pelve masculina, mostruário com as relações anatômicas prostáticas, simulador do EDR e DVD com animação tridimensional dos órgãos pélvicos. O grau de desconforto foi medido através da escala visual de dor. Utilizou-se o teste do qui-quadrado, com significância de 0,05. RESULTADOS: Houve diferença significativa entre o grau de desconforto referido no EDR entre os dois grupos, 81 por cento do grupo B referiram-no como leve e 80 por cento do grupo A, como moderado ou intenso, com p significativo de 0,01. Os sinais e sintomas foram a principal razão da consulta em 35 por cento dos pacientes, 78 por cento foram à consulta sozinhos e 81 por cento comentaram o exame com a parceira. Sem diferença estatística, 94,2 por cento no grupo A e 97,8 por cento no grupo B repetiriam o exame no ano seguinte e 91,6 por cento no grupo A e 96,6 por cento no grupo B relataram que o exame não foi pior do que imaginavam. Todos recomendariam o EDR para parentes ou amigos. CONCLUSÃO: Os pacientes que fizeram o EDR pela primeira vez após consulta urológica com esclarecimentos educativos prévios sobre o tema referiram significativamente menor desconforto.

OBJECTIVE: To assess the degree of discomfort reported by elderly men when first submitted to digital rectal examination (DRE) in the prevention of prostate cancer and the effect of previous explanations on this complaint. METHODS: A prospective, randomized study in 120 men aged 60 to 80 years, divided into two groups: group A (routine medical appointment) and group B (medical appointment with educational intervention). In group B, the information tools were informal talk with explanations of DRE and prostate cancer, visualization of model of the male pelvis and the anatomical relations with the prostate, DRE simulator and DVD with three-dimensional animation of the pelvic organs. The degree of discomfort was measured by visual scale of pain. We used the chi-square test, with significance at 0.05. RESULTS: There were significant differences between the degree of discomfort mentioned in DRE between the two groups; 81 percent of group B reported it as mild, while 80 percent of group A referred it as moderate or intense, with significant p=0.01. The signs and symptoms were the main reason for consultation in 35 percent of patients; 78 percent went to be consulted alone and 81 percent commented on their own examination with their spouses. With no statistical difference, 94.2 percent in group A and 97.8 percent in group B repeated the examination the following year and 91.6 percent in group A and 96.6 percent in group B reported that the exam was not worse than imagined. All would recommend DRE for relatives or friends. CONCLUSION: Patients who did the first DRE after urological consultation with prior educational clarification on the issue reported significantly less discomfort.

Patient positioning during digital rectal examination of the prostate: preferences, tolerability, and results.

PURPOSE: To evaluate the preferred position used by Brazilian Urologists to perform DRE, the position that Brazilian patients prefer or think it is less embarrassing to have a DRE, and to evaluate the results of DRE with patients in left lateral decubitus, modified lithotomy, standing-up, or the physician will have them place their elbows on the table and squat down slightly. MATERIALS AND METHODS: Brazilian Urologists were contacted by e-mail, and 200 patients answered a questionnaire while undergoing prostate cancer screening. RESULTS: The preferred position was modified lithotomy position reported by 63.4% of Urologists, and left lateral position reported by 42.7% of the patients. Total DRE time was lower in the standing-up position. Pain and urinary urgency scores were similar regardless of the position used, and bowel urgency score was higher in patients squatting down. Patients were similar in terms of age and PSA level, but there was a significant difference between the standard deviations of estimated prostate weight in left lateral position. There were no differences in prostate asymmetry, positive DRE, or incomplete palpation of the prostate rates among different examination positions. CONCLUSIONS: Despite individual subjective preferences, a faster examination time in the standing-up position, and higher bowel urgency scores in patients with their elbows placed on the table and squatting down slightly, there were similar rates of prostate asymmetry, positive DRE, and incomplete palpation of the prostate, and comparable patient tolerability among different examination techniques.

Patient positioning during digital rectal examination of the prostate: preferences, tolerability, and results

PURPOSE: To evaluate the preferred position used by Brazilian Urologists to perform DRE, the position that Brazilian patients prefer or think it is less embarrassing to have a DRE, and to evaluate the results of DRE with patients in left lateral decubitus, modified lithotomy, standing-up, or the physician will have them place their elbows on the table and squat down slightly. MATERIALS AND METHODS: Brazilian Urologists were contacted by e-mail, and 200 patients answered a questionnaire while undergoing prostate cancer screening. RESULTS: The preferred position was modified lithotomy position reported by 63.4 percent of Urologists, and left lateral position reported by 42.7 percent of the patients. Total DRE time was lower in the standing-up position. Pain and urinary urgency scores were similar regardless of the position used, and bowel urgency score was higher in patients squatting down. Patients were similar in terms of age and PSA level, but there was a significant difference between the standard deviations of estimated prostate weight in left lateral position. There were no differences in prostate asymmetry, positive DRE, or incomplete palpation of the prostate rates among different examination positions. CONCLUSIONS: Despite individual subjective preferences, a faster examination time in the standing-up position, and higher bowel urgency scores in patients with their elbows placed on the table and squatting down slightly, there were similar rates of prostate asymmetry, positive DRE, and incomplete palpation of the prostate, and comparable patient tolerability among different examination techniques.

[Indication for and execution of rectal examination in children with suspected appendicitis]. / Szemlélet- és gyakorlatváltozás a rectalis digitális vizsgálat indikációjában és kivitelezésben appendicitis acuta gyanúja esetén gyermekkorban.

Digital rectal examination is considered a non-evident diagnostic procedure in suspected appendicitis. It is rather unpleasant for children and there is a wide range of laboratory and imaging modalities available to contribute to the decision making in case a surgical intervention is necessary. In recent years digital rectal examination is not routinely used prior to surgery, however it may remain a useful screening method for patients with unclear clinical diagnosis. In such cases considering the important moral and legal arguments about digital rectal examination, we consider performing it under general anaesthesia.

Does clarifyng the digital rectal examination to the elderly reduce the discomfort in its first execution?

OBJECTIVE: To assess the degree of discomfort reported by elderly men when first submitted to digital rectal examination (DRE) in the prevention of prostate cancer and the effect of previous explanations on this complaint. METHODS: A prospective, randomized study in 120 men aged 60 to 80 years, divided into two groups: group A (routine medical appointment) and group B (medical appointment with educational intervention). In group B, the information tools were informal talk with explanations of DRE and prostate cancer, visualization of model of the male pelvis and the anatomical relations with the prostate, DRE simulator and DVD with three-dimensional animation of the pelvic organs. The degree of discomfort was measured by visual scale of pain. We used the chi-square test, with significance at 0.05. RESULTS: There were significant differences between the degree of discomfort mentioned in DRE between the two groups; 81% of group B reported it as mild, while 80% of group A referred it as moderate or intense, with significant p=0.01. The signs and symptoms were the main reason for consultation in 35% of patients; 78% went to be consulted alone and 81% commented on their own examination with their spouses. With no statistical difference, 94.2% in group A and 97.8% in group B repeated the examination the following year and 91.6% in group A and 96.6% in group B reported that the exam was not worse than imagined. All would recommend DRE for relatives or friends. CONCLUSION: Patients who did the first DRE after urological consultation with prior educational clarification on the issue reported significantly less discomfort.

Effects of prostate manipulation on serum total and free prostate specific antigen, and free-to-total prostate specific antigen ratio.

OBJECTIVE: To evaluate the effects of the different types of manipulation on prostate total specific antigen (tPSA), free prostate specific antigen (fPSA), and free-to-total prostate specific antigen (f/tPSA). METHODS: A total of 160 males were enrolled from January 2006 to December 2009 in the Urology Department, Beijing Anzhen Hospital affiliated to the Capital Medical University, Beijing, China. Of these patients, 23 had digital rectal examination (DRE), 21 had urethral catheterization, 28 had rigid cystoscopy, 35 had prostate biopsy, 35 underwent transurethral resection of the prostate (TURP), and 18 underwent suprapubic prostatectomy. Blood samples were taken before, at 24 hours, and 4 weeks after the manipulation for PSA tests. RESULTS: The DRE had no significant effect on PSA. Catheterization and cystoscopy exerted significant increases in tPSA at 24 hours. However, these small increases may not be clinically significant. The fPSA and f/tPSA were not significantly changed. There was a marked increase in tPSA and fPSA, associated with a decrease in f/tPSA at 24 hours after biopsy. No significant alterations were found in tPSA, fPSA, and f/tPSA at 4 weeks after catheterization, cystoscopy, and biopsy. The TURP and prostatectomy caused significant increases in tPSA and fPSA at 24 hours, associated with decreases in f/tPSA. The tPSA and fPSA values were below the baseline levels at 4 weeks after TURP and prostatectomy, however, f/tPSA remained constant. CONCLUSION: The DRE, catheterization, and cystoscopy had no crucial effect on PSA. Prostatic biopsy, TURP and prostatectomy significantly affected the PSA levels, and their longitudinal courses should be considered while evaluating different forms of PSA levels.

Mortality results from a randomized prostate-cancer screening trial.

BACKGROUND: The effect of screening with prostate-specific-antigen (PSA) testing and digital rectal examination on the rate of death from prostate cancer is unknown. This is the first report from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial on prostate-cancer mortality. METHODS: From 1993 through 2001, we randomly assigned 76,693 men at 10 U.S. study centers to receive either annual screening (38,343 subjects) or usual care as the control (38,350 subjects). Men in the screening group were offered annual PSA testing for 6 years and digital rectal examination for 4 years. The subjects and health care providers received the results and decided on the type of follow-up evaluation. Usual care sometimes included screening, as some organizations have recommended. The numbers of all cancers and deaths and causes of death were ascertained. RESULTS: In the screening group, rates of compliance were 85% for PSA testing and 86% for digital rectal examination. Rates of screening in the control group increased from 40% in the first year to 52% in the sixth year for PSA testing and ranged from 41 to 46% for digital rectal examination. After 7 years of follow-up, the incidence of prostate cancer per 10,000 person-years was 116 (2820 cancers) in the screening group and 95 (2322 cancers) in the control group (rate ratio, 1.22; 95% confidence interval [CI], 1.16 to 1.29). The incidence of death per 10,000 person-years was 2.0 (50 deaths) in the screening group and 1.7 (44 deaths) in the control group (rate ratio, 1.13; 95% CI, 0.75 to 1.70). The data at 10 years were 67% complete and consistent with these overall findings. CONCLUSIONS: After 7 to 10 years of follow-up, the rate of death from prostate cancer was very low and did not differ significantly between the two study groups. (ClinicalTrials.gov number, NCT00002540.)

Patient's reactions to digital rectal examination of the prostate.

OBJECTIVE: In recent years, there has been a rise in the incidence of prostate cancer (PCa), and routine screening for the disease has become a well accepted clinical practice. Even with the recognized benefit of this approach, some men are still reluctant to undergo digital rectal examination (DRE). For this reason, we designed the present study in order to better understand men's reactions about this method of screening. The aim was to identify possible drawbacks that could be overcome to increase DRE. MATERIALS AND METHODS: We randomly selected 269 patients that were enrolled in an institutional PCa screening program. They were first asked to answer a question regarding their preferred position to undergo the examination. Following this step, they answered a questionnaire in which physical and psychological reactions regarding the DRE were presented. Finally, we used a visual analogical scale (VAS) to analyze the perception of pain during DRE. RESULTS: The supine position was preferred for most patients (53.9%). Before DRE, about 59.4% of patients felt that the exam would be acceptable. After DRE, this figure increased to 91.5% (p < 0.001). Mean VAS score during DRE was 1.69 on a scale with a range between 0 and 10 (0 = no pain; 10 = extreme pain). CONCLUSION: Patient expectations about DRE were negative before examination and changed significantly following the exam. Pain during examination was negligible, contrary to the prevalent belief. These two findings must be clearly presented to patients in order to improve PCa screening acceptance.

Patients' perceptions of pain and discomfort during digital rectal exam for prostate cancer screening.

OBJECTIVE: To evaluate patients' perception of pain and discomfort during DRE, the impact of discomfort on potential future screening compliance, and if emptying the bladder immediately before DRE reduces patient discomfort. METHODS: One-hundred patients undergoing DRE for prostate cancer screening answered an anonymous questionnaire regarding pain, urinary urgency and bowel urgency during DRE and its potential impact on future examination. Another group with 100 patients was randomized in two subgroups to analyze if urinating immediately before DRE reduces patient discomfort. RESULTS: Seventy-three (73%) patients reported moderate or higher discomfort for at least one of the domains evaluated: 61% complained of pain; 22% of urinary urgency; and 22% of bowel urgency. Emptying the bladder immediately before examination did not reduce pain (58% vs. 50%, p = 0.115), urinary urgency (22% vs. 16%, p = 0.151), or bowel urgency intensity (16% vs. 14%, p = 0.264). There was no difference in the number of patients that answered they will repeat the prostate exam next year (96% vs. 90%, p = 0.211) or in those that would encourage a friend that needs the prostate exam to do it (96% vs. 98%, p = 0.378). CONCLUSIONS: Pain and discomfort during DRE are not negligible but they do not affect intention to have a prostate exam in the future. Urinating immediately before examination does not significantly reduce the incidence of pain, urinary urgency, or bowel urgency during DRE.

Patient's reactions to digital rectal examination of the prostate

OBJECTIVE: In recent years, there has been a rise in the incidence of prostate cancer (PCa), and routine screening for the disease has become a well accepted clinical practice. Even with the recognized benefit of this approach, some men are still reluctant to undergo digital rectal examination (DRE). For this reason, we designed the present study in order to better understand men's reactions about this method of screening. The aim was to identify possible drawbacks that could be overcome to increase DRE. MATERIALS AND METHODS: We randomly selected 269 patients that were enrolled in an institutional PCa screening program. They were first asked to answer a question regarding their preferred position to undergo the examination. Following this step, they answered a questionnaire in which physical and psychological reactions regarding the DRE were presented. Finally, we used a visual analogical scale (VAS) to analyze the perception of pain during DRE. RESULTS: The supine position was preferred for most patients (53.9 percent). Before DRE, about 59.4 percent of patients felt that the exam would be acceptable. After DRE, this figure increased to 91.5 percent (p < 0.001). Mean VAS score during DRE was 1.69 on a scale with a range between 0 and 10 (0 = no pain; 10 = extreme pain). CONCLUSION: Patient expectations about DRE were negative before examination and changed significantly following the exam. Pain during examination was negligible, contrary to the prevalent belief. These two findings must be clearly presented to patients in order to improve PCa screening acceptance.

Rectovaginal examinations and human papillomavirus: can we decrease the risk of colorectal infection?

Rectovaginal examination with gloves contaminated with vaginal secretions might increase the risk of human papillomavirus (HPV) inoculation of the rectum in women with genital HPV infections. Because of the high prevalence of asymptomatic genital HPV infections, and the association between HPV and colorectal malignancy, examination gloves should be changed between vaginal and rectal examinations.

Can pain during digital rectal examination help us to decide the necessity and the method of anesthesia for transrectal ultrasound guided prostate needle biopsy?

OBJECTIVE: Transrectal ultrasound (TRUS) guided prostate biopsy is well tolerated by patients but the lack of an effective marker to predict pain prevents us from determining pre-procedurally which patient group needs local anesthesia for biopsy and probe pain. Thus in this study, we investigated predictor factors for prostate biopsy and probe insertion pain. MATERIALS AND METHODS: 71 patients who were undergoing prostate biopsy without anesthesia were included in the study retrospectively. Pain had been assessed with visual analogue scale (VAS 0-10). Digital rectal examination (DRE) pain was analyzed for biopsy and probe insertion pain. RESULTS: DRE pain was related to both probe pain and biopsy pain. CONCLUSION: Although level of pain during DRE determines patients in need of local anesthesia, since the number of patients with moderate-severe pain is rather big, it seems efficient in determining the patients in need of additional anesthesia due to probe pain.

Can pain during digital rectal examination help us to decide the necessity and the method of anesthesia for transrectal ultrasound guided prostate needle biopsy?

OBJECTIVE: Transrectal ultrasound (TRUS) guided prostate biopsy is well tolerated by patients but the lack of an effective marker to predict pain prevents us from determining pre-procedurally which patient group needs local anesthesia for biopsy and probe pain. Thus in this study, we investigated predictor factors for prostate biopsy and probe insertion pain. MATERIALS AND METHODS: 71 patients who were undergoing prostate biopsy without anesthesia were included in the study retrospectively. Pain had been assessed with visual analogue scale (VAS 0-10). Digital rectal examination (DRE) pain was analyzed for biopsy and probe insertion pain. RESULTS: DRE pain was related to both probe pain and biopsy pain. CONCLUSION: Although level of pain during DRE determines patients in need of local anesthesia, since the number of patients with moderate-severe pain is rather big, it seems efficient in determining the patients in need of additional anesthesia due to probe pain.