[Validity of digital rectal examination in the era of prostate specific antigen]. / Validez diagnóstica del tacto rectal en la era del antígeno específico de la próstata.

OBJECTIVE: To determine the presence of a possible correlation between prostate specific antigen (PSA) and the findings from digital rectal examination (DRE) in patients with prostate cancer or benign prostatic hyperplasia. DESIGN: Retrospective, longitudinal, and observational study of diagnostic tests. SETTING: Gregorio Marañón Hospital, Madrid, Spain. PARTICIPANTS: It included 706 patients with a PSA in the range 4.1-20 ng/mL, studied owing to suspected prostate cancer localised using DRE and transrectal ultrasound, in whom randomised prostate biopsies were performed. MAIN MEASUREMENTS: Total PSA and free/total PSA ratio and DRE normal or suspicious were studied as main variables. The outcome variable was the diagnosis of prostatic cancer by biopsy. RESULTS: With a detection of cancer of 28.2%, there were no statistically significant differences in the PSA or free/total PSA ratio mean values between patients with or without suspicious DRE. The analysis using ROC curves (with a 95% confidence interval) between both groups of patients found the same sensitivity of 95% with a similar specificity of 6% and 10%, respectively, for a PSA of 4.8 ng/mL. CONCLUSIONS: In the PSA range of 4.1-20 ng/mL, the findings of DRE appeared as a variable unrelated to the increase in PSA or the free/total PSA ratio and, therefore are not indicative of a lesser or greater volume of a tumour producing PSA. The performing of this examination could be considered as optional.

Validez diagnóstica del tacto rectal en la era del antígeno específico de la próstata / Validity of digital rectal examination of prostate specific antigen

Objetivo. Determinar la posible correlación entre los valores del antígeno específico de la próstata (PSA) y los hallazgos del tacto rectal en pacientes con cáncer prostático y enfermedad prostática benigna. Diseño. Estudio de evaluación de pruebas diagnósticas de tipo retrospectivo, longitudinal, con carácter observacional. Emplazamiento. Hospital Gregorio Marañón, Madrid. Participantes. Se incluyó a 706 pacientes con PSA en el rango de 4,1-20 ng/ml estudiados por sospecha de cáncer prostático localizado mediante tacto rectal y ecografía transrectal, en los que se realizaron biopsias prostáticas aleatorizadas. Mediciones principales. Se estudiaron como variables predictoras el PSA total, el cociente PSA libre/total y el tacto rectal categorizado como normal o sospechoso de cáncer. La variable desenlace fue el diagnóstico de cáncer prostático obtenido mediante biopsia. Resultados. Con una detección de cáncer del 28,2%, no se encontraron diferencias estadísticamente significativas en los valores medios de PSA o PSA libre/total entre los pacientes sin/con tacto rectal sospechoso. El análisis mediante curvas ROC (con un intervalo de confianza del 95%) entre ambos grupos de pacientes encontró para el PSA en el valor de 4,8 ng/ml una misma sensibilidad del 95%, con una especificidad similar, del 6 y el 10%, respectivamente. Conclusiones. En el rango de PSA 4,1-20 ng/ml, los hallazgos del tacto rectal aparecieron como una variable sin relación con la elevación del PSA ni con el cociente PSA libre/total y, por tanto, no son indicativos de un menor o mayor volumen tumoral productor de PSA. La realización de esta exploración podría ser considerada como opcional

Objective. To determine the presence of a possible correlation between prostate specific antigen (PSA) and the findings from digital rectal examination (DRE) in patients with prostate cancer or benign prostatic hyperplasia. Design. Retrospective, longitudinal, and observational study of diagnostic tests. Setting. Gregorio Marañón Hospital, Madrid, Spain. Participants. It included 706 patients with a PSA in the range 4.1-20 ng/mL, studied owing to suspected prostate cancer localised using DRE and transrectal ultrasound, in whom randomised prostate biopsies were performed. Main measurements. Total PSA and free/total PSA ratio and DRE normal or suspicious were studied as main variables. The outcome variable was the diagnosis of prostatic cancer by biopsy. Results. With a detection of cancer of 28.2%, there were no statistically significant differences in the PSA or free/total PSA ratio mean values between patients with or without suspicious DRE. The analysis using ROC curves (with a 95% confidence interval) between both groups of patients found the same sensitivity of 95% with a similar specificity of 6% and 10%, respectively, for a PSA of 4.8 ng/mL. Conclusions. In the PSA range of 4.1-20 ng/mL, the findings of DRE appeared as a variable unrelated to the increase in PSA or the free/total PSA ratio and, therefore are not indicative of a lesser or greater volume of a tumour producing PSA. The performing of this examination could be considered as optional

[Impotence in diabetic patients: detection of prevalence and social-health implications]. / Impotencia en pacientes diabéticos: detección de prevalencia e implicaciones sociosanitarias.

OBJECTIVES: To classify information received from diabetics on erectile dysfunction (ED) and to find whether help is being sought or there is just passive resignation. DESIGN: Epidemiological, descriptive, crossover study. SETTING: Urban Health Centre. PATIENTS: 102 patients involved in the Diabetes Programme for over a year were studied. MEASUREMENTS AND MAIN RESULTS: A data collection sheet with the variables listed under objectives was designed. Average age was 63 +/- 12. Overall prevalence of ED was 56%, age being the most important related variable found (p < 0.01). 30% of patients with ED had requested medical care; only 18% had been treated. However, 54% of impotent diabetics accepted the theoretical possibility of treatment with intracavernous injections. CONCLUSIONS: A high prevalence of ED was detected in the diabetic patients studied. They considered the medical information on possible treatments scant (18%) and generally inadequate. Most preferred to be treated by the Primary Care doctor. Primary Care professionals must become more sensitive to ED and provide correct therapeutic information.