Digital Rectal Exam Does Not Detect Early-Stage Prostate Cancer

TUESDAY, March 21, 2023 (HealthDay News) -- A digital rectal exam (DRE) conducted in men at age 45 years seems not to be useful for detecting early-stage prostate cancer, according to a study presented at the annual congress of the European Association of Urology, held from March 10 to 13 in Milan.

Noting that the German statutory early detection program recommends DRE as a standalone screening test starting annually at age 45 years, Agne Krilaviciute, Ph.D., from DKFZ in Heidelberg, Germany, and colleagues examined the diagnostic performance of DRE in young men.

The researchers found that 57 of the 6,537 men who accepted a DRE at age 45 years were suspicious for cancer; 37 underwent immediate biopsy detecting two prostate cancers. In the remaining 55 participants, one additional cancer was detected by DRE repeated two years later in an individual who refused initial biopsy. At age 45 years, biopsy showed prostatitis, benign prostate hyperplasia, high-grade prostatic intraepithelial neoplasia, and atypical small acinar proliferation in 16, 14, one, and one men, respectively; findings were unclear in three men. Of the 54 men without prostate cancer detected before re-invitation to the study, 28 underwent prostate-specific antigen (PSA) testing five years later, and in one individual, PSA was >3 ng/mL. That individual had benign prostate hyperplasia on biopsy at age 50 years.

"We speculate in our paper that not only is the DRE not useful for detecting cancer, but it may also be one reason why people don't come to screening visits -- the examination probably puts a lot of men off," a coauthor said in a statement.

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