A study presented by German scientists at the Annual Congress of the European Association of Urology in Milan claimed that digital rectal examination – also called digital rectal examination – would not be the best for detecting prostate cancer at an early stage, but measuring the concentration of the total prostate specific antigen (PSA).
The doctor is professor of Internal Medicine and Laboratory Medicine at the Paulista School of Medicine at UNIFESP and former president of the Brazilian Society of Clinical Pathology and Labor Medicine (SBPC/ML), Dr. Adagmar Andriolo clarifies that the digital rectal examination remains an important resource adopted by urologists for the diagnosis of the disease.
The expert clarifies that laboratory tests, such as the measurement of PSA (Prostate-Specific Antigen), with calculations of the free PSA ratio over Total, and PHI (Prostate Health Index) and others, are complementary.
“One does not exclude the other, therefore, both resources must be performed initially even to look for cancer early. Additionally, most of the time, in the face of an elevated PSA, imaging methods such as magnetic resonance imaging are performed, and only, finally, pathological anatomy, biopsy, which helps or confirms the diagnosis.
For the suspicion and subsequent diagnosis of prostate cancer, several aspects must be considered and, for this reason, consultation with the urologist is very necessary. Among these aspects, we emphasize the age of the patient, his personal and family history, anatomical characteristics of the gland, among others.
“For example, individuals over 50 years of age are at greater risk of having this type of cancer, as well as those with a family history in which first-degree relatives have had cancer before the age of 50,” details physician Professor Adagmar Andriolo.
In the face of evidence of tumors, digital rectal examination is also used to direct the biopsy, if necessary, in order to reduce the risk of false negative results. The doctor points out that the prostate exam does not necessarily have to be annual, it can be performed more frequently, at the discretion of the urologist, based on individual risk.
“The age of 50 for the first digital rectal exam and eventual measurement of PSA concentration is only for people without close relatives with cancer. If the person had a brother who presented the tumor before the age of 45, the ideal thing is that he also starts investigating at the same age or even a little earlier”, he says.
A few years ago, the validity of carrying out the PSA test as a population screening was much discussed, having been contraindicated by international scientific entities.
“This decision was based on the fact that many patients were referred for biopsy based on altered PSA levels and the results were negative for the presence of cancer. The total suppression of this PSA measurement feature, however, has led to a large number of patients being diagnosed in more advanced stages of the disease, when treatment is less effective. Based on this finding, the recommendations were reviewed and, at present, the PSA test should be ordered after an adequate assessment of the individual’s risk and awareness of its limitations. In the face of alteration, imaging and biopsy are performed as a last resort in most cases”, explains Andriolo.
SBPC/ML
The Brazilian Society of Clinical Pathology and Laboratory Medicine is an association governed by private law for non-economic purposes, founded on May 31, 1944. Its purpose is to bring together Doctors, holders of the Title of Specialist in Clinical Pathology/Laboratory Medicine and Doctors of other specialties , regularly enrolled in their respective Regional Councils of Medicine, and individuals and legal entities that, directly or indirectly, are linked to Clinical Pathology/Laboratory Medicine, and always encourage the enhancement of the Specialty within ethical-scientific standards.
Members include clinical pathologists and other specialties (such as pharmacists-biochemists, biophysicians, biologists, technicians and other clinical laboratory professionals, university and high school students). Clinical laboratories and manufacturers and distributors of equipment, products and services for laboratories can also join.
Over the last few decades, SBPC/ML has promoted scientific improvement in Laboratory Medicine, seeking continuous improvement of processes, evolution of science, technology and regulation of the sector, with the main objective of permanently qualifying the health care of the Brazilian.
