Men referred with abnormal DRE findings in combination with an elevated PSA have a higher odds of clinically significant prostate cancer than elevated PSA or abnormal DRE alone

Objective: The objective of the study is to evaluate rates of clinically significant prostate cancer (CSPC) in patients referred with abnormal DRE, elevated PSA or both, on the NHS England Best-Timed Pathway for Prostate Cancer (BTiPP). Patients and Method: Patients referred on a BTiPP in 2021 were grouped into Abnormal DRE with Normal PSA, Elevated PSA with Normal DRE and Abnormal DRE with Elevated PSA. The primary outcome was diagnosis of CSPC. For patients who underwent an MRI, a secondary outcome was abnormal MRI. Multivariate logistic regression models were developed to estimate adjusted odds ratios (aORs) for CSPC and abnormal MRI. Results: A total of 399 patients were included for analysis. Age was comparable across the groups. Compared with the Abnormal DRE with Normal PSA group, the odds of CSPC were significantly higher in the Abnormal DRE with Elevated PSA group (aOR = 6.81; p < 0.01) but not the Elevated PSA with Normal DRE group (aOR = 1.32; p = 0.46). A total of 291 patients underwent MRI and compared with the Abnormal DRE with Normal PSA group the odds of abnormal MRI were significantly higher in the Abnormal DRE with Elevated PSA group but not in the Elevated PSA with Normal DRE group. Conclusion: Abnormal DRE with Elevated PSA is associated with higher odds of CSPC and abnormal MRI, compared with Elevated PSA with Normal DRE or Abnormal DRE with Normal PSA. About 12.4% of Abnormal DRE with Normal PSA patients were diagnosed with CSPC. This highlights the continued relevance of DRE in men referred with suspected prostate cancer. Level of evidence: 3b (single case-control study)