{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:19:09Z","timestamp":1790687949619,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,2,19]],"date-time":"2018-02-19T00:00:00Z","timestamp":1518998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Prostate Conditions Education Council"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Prostate"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The 4Kscore is a new commercially available blood\u2010based diagnostic test which predicts risk for aggressive, clinically significant prostate cancer on prostate biopsy. The 4Kscore is currently restricted to patients who have not had a digital rectal exam (DRE) in the previous 96\u2009h, owing to prior mixed data suggesting that prostate specific antigen (PSA) isoforms may increase by a statistically significant\u2014if not necessarily clinically significant\u2014amount shortly after DRE. Our primary objective was to determine if 4Kscore test results are affected by a preceding DRE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants at a Prostate Cancer Awareness Week screening event sponsored by the Prostate Conditions Education Council filled out clinical history questionnaires and had blood samples for 4Kscore testing drawn prior to DRE, then 15\u201045\u2009min following DRE. Patients with prior cancer diagnosis, 5\u2010alpha reductase inhibitor medication use, or lower urinary tract procedures in the prior 6 months were excluded, resulting in a population of 162 participants for analysis. Values were then compared to determine if there was a significant difference in 4Kscore following DRE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A statistically significant increase was seen in levels of 3 kallikreins measured (total PSA, free PSA, and intact PSA; median &lt;0.03\u2009ng\/mL for all). This resulted in a small but statistically significant decrease in post\u2010DRE 4Kscore (median absolute score decrease 0.43%). Using a 4Kscore cutoff of 7.5% resulted in reclassification of 10 patients (6.2%), nine of whom were \u201cdowngraded\u201d from above the cutoff to below.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>If the blood draw for the 4\u2009K score is performed after a screening DRE, there is a statistically significant difference in the 4\u2009K score results, but in the vast majority of cases it would not affect clinical decision making.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pros.23495","type":"journal-article","created":{"date-parts":[[2018,2,23]],"date-time":"2018-02-23T16:57:58Z","timestamp":1519405078000},"page":"506-511","source":"Crossref","is-referenced-by-count":8,"title":["The effect of digital rectal exam on the 4Kscore for aggressive prostate cancer"],"prefix":"10.1002","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2629-3310","authenticated-orcid":false,"given":"Michael A.","family":"Maccini","sequence":"first","affiliation":[{"name":"University of Colorado Anschutz Medical Campus Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Westfall","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrie","family":"Van Bokhoven","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marshall Scott","family":"Lucia","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Poage","sequence":"additional","affiliation":[{"name":"Prostate Condition Education Council Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul D.","family":"Maroni","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shandra S.","family":"Wilson","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard Michael","family":"Glod\u00e9","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Arangua","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Newmark","sequence":"additional","affiliation":[{"name":"OPKO Health Miami Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Steiner","sequence":"additional","affiliation":[{"name":"OPKO Health Miami Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya N.","family":"Werahera","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elward David","family":"Crawford","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-6-19"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-10-0122"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6605815"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-10-1003"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2013.04.040"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2014.10.021"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.24.1968"},{"key":"e_1_2_8_9_1","unstructured":"OPKO Lab Nashville TN. 4Kscore Clinical Kit Revision 2.2014. 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