Study: Digital Rectal Exams May Miss Early Prostate Cancer
March 9, 2023 – New studies occasionally appear that cast doubt on the accepted practice of medicine. In this instance, a German study casts doubt on the efficacy of digital rectal examinations for identifying prostate cancer, particularly in its early stages.
Between 2014 and 2019, researchers enrolled 46,495 men in the PROBASE trial who had a prostate cancer screening at age 45. A digital rectal exam (DRE), in which a doctor uses a finger to feel for lumps or unusual enlargement in the prostate gland, was made available to half of the men. Five years later, at age 50, they underwent a prostate-specific antigen blood test. At age 45, just the PSA test was made available to the other half.
The PSA test discovered four times as many cases of early prostate cancer as a digital rectal exam alone, according to lead researcher Agne Krilaviciute, PhD, and colleagues.
To find prostate cancer in patients as soon as possible is one of the primary goals of screening, according to Krilaviciute, a researcher at the Heidelberg-based German Cancer Research Center, Deutsches Krebsforschungszentrum. Our research indicates that the DRE is insufficiently sensitive to identify those early-stage malignancies.
Instead of digital rectal exams, the researchers advise using PSA tests and MRI scans to evaluate men for prostate cancer. The results were presented in Milan at the annual meeting of the European Association of Urology.
6,537 of the 23,194 participants in the delayed PSA group underwent a rectal exam. 57 people in this cohort underwent a biopsy due to worrisome findings. Three of them had prostate cancer, according to the diagnosis.
“We hypothesise in our paper that not only is the DRE not useful for detecting cancer, but that it may also be one reason why people don’t come to screening visits – the examination probably puts off a lot of men,” Krilaviciute said. “For instance, in Germany, the screening programme for men between the ages of 45 and 50 has a participation rate of less than 20%. More of them might be willing to attend if we offered PSA testing instead.
