Ditch the digital rectal exam, researchers say

It's time to do away with the digital rectal examination (DRE) for detecting prostate cancer, according to a study by urologists in Current Medical Research and Opinion.

“The evidence suggests that, in most cases, it is time to abandon the digital rectal exam,” said lead researcher Ryan Terlecki, MD, Associate Professor of Urology at Wake Forest University School of Medicine, in Winston-Salem, NC. “Our findings will likely be welcomed by patients and doctors alike.”

The study comes in the wake of the 2012 U.S. Preventive Services Task Force recommendations against prostate specific antigen (PSA) screening for prostate cancer. However, the recommendations didn’t say much about DRE screening (which some urologists refer to as a “clinical relic,” the researchers noted).

“Many practitioners continue to perform DRE in attempts to identify men with aggressive prostate cancer who could die from the disease,” Dr. Terlecki said. “In the era of PSA testing, we wanted to explore whether it’s time to abandon the digital exam.”

For this study, he and his colleagues reviewed data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial, a nationwide study of 38,340 men who received annual DRE exams and PSA tests for at least 3 years, and were then followed for up to 13 years. Of these men, 5,064 had normal PSA results but abnormal DREs. However, only 2% of these men were diagnosed with clinically significant prostate cancer.

“This incremental gain suggests that routine DRE screening subjects a large number of men to invasive, potentially uncomfortable examinations for relatively minimal gain,” the authors wrote in their article.

The results of this research also confirmed previous studies that showed PSA is superior to DRE as an independent screen for prostate cancer. In this study, PSA testing detected 680 cases of clinically significant prostate cancer, while DRE detected 317 cases (with most of those also having abnormal PSA).

“When PSA testing is used, the DRE rarely assists in diagnosing significant disease,” Dr. Terlecki explained. “In cases where PSA testing is used, the DRE should be abandoned in common clinical practice.”

For certain patients, though, DRE may still be useful, Dr. Terlecki noted. It might spark an important dialogue about prostate cancer screening. For example, a patient with abnormal PSA who is hesitant to have a biopsy may feel more comfortable proceeding with the procedure if a DRE is also abnormal, he said.