In a nutshell: A finger up your bum to examine your prostate is not a great way to screen for prostate cancer. We need better screening options. 

It could be perceived as a barrier to prostate cancer screening. Blokes don’t like the idea of digital rectal examination (DRE). And many examinations done my doctors don’t have a great pick up rate. The whole idea of DRE is that the doctor feels your prostate gland for any irregularities. Any nodules or other hardness may suggest prostate cancer. But how good is it?

This systematic review found seven studies with 9,241 patients to include in the analysis. All of those patients had DRE but they also went on to have a biopsy – so it gives us good information on whether they did actually have prostate cancer in the end.

The results showed that sensitivity (0.51) and specificity (0.59) were low. Basically, DRE misses loads of prostate cancer and when it is abnormal it is very often not prostate cancer (which means unnecessary investigations and tests).

There are a couple of important points here. Proposed screening programmes may use a combination of examinations, blood tests etc and so don’t go rushing around refusing to have a rectal exam without considering all the aspects of the programme.

And, most crucially, remember that this is about screening. That’s checking men who have no symptoms – this is absolutely not about using DRE part of an assessment when you have symptoms.

More than anything, what this highlights is that we need better tests and better ways of screening for prostate cancer. The current offering of DRE and PSA testing is not good. And that’s why we don’t have a population-based screening programme at this time. Let’s hope future research can help with that.

Reference: Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis. 2018;16:149–54. doi:10.1370/afm.2205
https://www.ncbi.nlm.nih.gov/pubmed/29531107

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