The role of the digital rectal examination as diagnostic test for prostate cancer detection in obese patients.

PURPOSE Digital rectal examination (DRE) is a routine part of prostate cancer Purpose: Digital rectal examination (DRE) is a routine part of prostate cancer (PCa) screening and provides important prognostic information. The purpose of this study was to analyse the potential association between obese patients and DRE findings for PCa detection. METHODS We retrospectively reviewed the medical records of patients who underwent an initial prostate needle biopsy for abnormal DRE, high prostate specific antigen (PSA) levels (≥4 ng/mL), or both at the Department of Urology. Patients with a history of biopsy, surgical treatment of prostatic disease, or incomplete clinical data were excluded from this study. A total of 1113 patients were included in the analysis. Before the biopsy procedure body mass index (BMI) was calculated. Age, PSA, BMI, DRE findings, prostate volume and Gleason score were analysed to assess the potential association between obesity and PCa detection. RESULTS The mean + SD BMI was 28.3 + 4.1 kg/m2. A total of 373 (33.5%) patients were classified as obese (BMI ≥30 kg/m2). No significant difference was noted in the number of biopsy cores between obese and non obese patients. The obese men were older, had a lower PSA concentration, a large prostate volume, and were less likely to have abnormal DRE findings. Patients with high grade prostate cancer (HGPCa) had higher BMI. Age, PSA and prostate volume were not significantly associated with a higher risk of cancer at biopsy. CONCLUSIONS Our data demonstrated that obese patients have lower PSA levels, larger prostates and abundant perirectal fat. Lower PSA serum levels and large prostate size associated with high BMI, indicated a potential risk for delayed diagnosis and poor pathological outcomes.PCa) screening and provides important prognostic information. The purpose of this study was to analyse the potential association between obese patients and DRE findings for PCa detection. METHODS We retrospectively reviewed the medical records of patients who underwent an initial prostate needle biopsy for abnormal DRE, high prostate specific antigen (PSA) levels (≥4 ng/mL), or both at the Department of Urology. Patients with a history of biopsy, surgical treatment of prostatic disease, or incomplete clinical data were excluded from this study. A total of 1113 patients were included in the analysis. Before the biopsy procedure body mass index (BMI) was calculated. Age, PSA, BMI, DRE findings, prostate volume and Gleason score were analysed to assess the potential association between obesity and PCa detection. RESULTS The mean + SD BMI was 28.3 + 4.1 kg/m(2). A total of 373 (33.5%) patients were classified as obese (BMI ≥30 kg/m(2)). No significant difference was noted in the number of biopsy cores between obese and non obese patients. The obese men were older, had a lower PSA concentration, a large prostate volume, and were less likely to have abnormal DRE findings. Patients with high grade prostate cancer (HGPCa) had higher BMI. Age, PSA and prostate volume were not significantly associated with a higher risk of cancer at biopsy. CONCLUSIONS Our data demonstrated that obese patients have lower PSA levels, larger prostates and abundant perirectal fat. Lower PSA serum levels and large prostate size associated with high BMI, indicated a potential risk for delayed diagnosis and poor pathological outcomes.