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<h5 class="section-title" id="d7531428e211">PURPOSE</h5>
<p id="d7531428e213">Although the digital rectal examination (DRE) is commonly performed
to screen for
prostate cancer, there is limited data to support its use in primary care. This review
and meta-analysis aims to evaluate the diagnostic accuracy of DRE in screening for
prostate cancer in primary care settings.
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<h5 class="section-title" id="d7531428e216">METHODS</h5>
<p id="d7531428e218">We searched MEDLINE, Embase, DARE (Database of Abstracts of Reviews
of Effects), Cochrane
Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and
CINAHL (Cumulative Index to Nursing and Allied Health Literature) from their inception
to June 2016. Six reviewers, in pairs, independently screened citations for eligibility
and extracted data. Pooled estimates were calculated for sensitivity, specificity,
positive predictive value (PPV), and negative predictive value (NPV) of DRE in primary
care settings using an inverse-variance meta-analysis. We used QUADAS-2 (Quality Assessment
of Diagnostic Accuracy Studies 2) and GRADE (Grades of Recommendation Assessment,
Development, and Evaluation) guidelines to assess study risk of bias and quality.
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<h5 class="section-title" id="d7531428e221">RESULTS</h5>
<p id="d7531428e223">Our search yielded 8,217 studies, of which 7 studies with 9,241
patients were included
after the screening process. All patients analyzed underwent both DRE and biopsy.
Pooled sensitivity of DRE performed by primary care clinicians was 0.51 (95% CI, 0.36–0.67;
I
<sup>2</sup> = 98.4%) and pooled specificity was 0.59 (95% CI, 0.41–0.76; I
<sup>2</sup> = 99.4%). Pooled PPV was 0.41 (95% CI, 0.31–0.52; I
<sup>2</sup> = 97.2%), and pooled NPV was 0.64 (95% CI, 0.58–0.70; I
<sup>2</sup> = 95.0%). The quality of evidence as assessed with GRADE was very low.
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<h5 class="section-title" id="d7531428e238">CONCLUSION</h5>
<p id="d7531428e240">Given the considerable lack of evidence supporting its efficacy,
we recommend against
routine performance of DRE to screen for prostate cancer in the primary care setting.
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