HWN Suggests

Is the digital rectal exam any good as a prostate cancer screening test?

There is no shortage of references in popular culture to the prostate examination, with many a laugh built on the punchline of the finger up the bum. Interestingly, while cervical, breast, or bowel screening share barriers to uptake around the intimacy of the examination, ‘ick-factor’, or cultural taboos, they have never become comedy tropes — reflecting the uniquely emasculating perception of the rectal examination.

read full article

Featured

 Is Era of the Digital Rectal Examination (DRE) for Prostate Cancer Detection and Management Over?

In summary, the role of DRE in the modern day diagnosis and management of prostate cancer is limited. Screening studies highlight extremely few scenarios whereby DRE alone detects prostate cancer. Imaging has largely assumed the role of local anatomic evaluation and staging. DRE may have continued value in the realm of active surveillance particularly if the intent is to control costs associated with ubiquitous use of imaging.

 The Prostate and the Digital Rectal Exam

“The DRE gives a whole new meaning to the term, ‘the doctor is in.’” Gogs shares what a digital rectal exam was like, and what the exam can mean for prostate cancer. Before my cancer diagnosis, I understood that men had prostates, but that was about the extent of my knowledge. The subject never came up in conversations, and I had no curious thoughts about it. I was more interested in the female anatomy.

Articles of Interest

Bad medicine: digital rectal examination

DRE is useless for follow up of prostate cancer patients Certainly from the prostate cancer point of view, I have to agree with Des Spence. With increasing use of PSA (prostate specific antigen), I agree that the role of DRE as a prostate cancer screening tool is almost obsolete.

Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis

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.

Digital Rectal Examination Is Not a Useful Screening Test for Prostate Cancer

The performance of stand-alone DRE to screen for PCa is poor. DRE should not be recommended as a PCa screening test in young men. Furthermore, DRE does not improve the detection of PSA-screen–detected PCa.

DRE exhibits low diagnostic value in prostate cancer detection

If we look at the diagnostic accuracy for prostate detection tools, we found no difference between DRE, the digital rectal exam, and PSA, or any type of combination between those 2, in the positive predictive value domains. If one is positive, you will have cancer. We find no difference. Even if you combine them, [there was] no added value of one to the other one in either way you looked at. The key end point that we thought is the most important is the cancer detection rate.

Omit Digital Rectal Exam in Prostate Cancer Surveillance?

Routine use of MRI during active surveillance of men with prostate cancer allows patients to skip digital rectal examinations and some biopsies, and this approach is best practice, according to an international panel of experts.

Prostate cancer test: is it time to ditch the digital rectal examination?

DRE performs rather better for rectal cancer. If the tumour is in a site accessible to the examiner’s finger, then up to 76% can be detected. For constipation, the finding of impacted stool in the rectum can save the expense and radiation exposure of modern investigations, which have done away with X-rays of the abdomen in favour of radiation-intensive CT scans. Has the rectal examination had its day? I think not. It’s a cheap examination that yields useful information when used and interpreted correctly.

Pull your finger out, doc, rectal exams aren’t the best way to find prostate cancer

But rectal examination is less accurate than the PSA blood test, missing more cancer and causing more false alarm.

The Value of Digital Rectal Examination (DRE) in Prostate Cancer Diagnostics

The value of DRE in modern diagnostics for PCA has been a matter of debate... Our data does not endorse the hypothesis that an abnormal DRE finding leads to a higher detection rate of prostate cancer. We recommend that PCA diagnostics can be safely undertaken remotely, without requiring face-to-face consultations for DRE,

What Happened to Getting a Doctor’s Finger in Your Butt?

Men were taught to fear it for decades. I was a little shocked what happened when I asked why it never happened to me.

Resources

Prostate Cancer UK

The DRE is not a completely accurate test. Your doctor or nurse can’t feel the whole prostate. And a man with prostate cancer might have a prostate that feels normal.