Digital rectal exam is not necessary

It features peer-reviewed original medical journal articles.

A recent review entitled “Is the Digital Rectal Exam Necessary All the Time” got my attention and, given the current heightened interest in the topic in respect of prostate cancer, I now share the unaltered version below so the TT public, particularly men, can go forward with widened perspectives.

“Our first study confirms that the digital rectal exam (DRE) is not necessary as a first-line screening test for prostate cancer.

In the nationwide (US) prostate, lung, colorectal and ovarian cancer screening trial involving 38,340 men, researchers found that the exam would need to be performed in almost 1,400 men with normal prostate-specific antigen (PSA) levels in order to detect a single case of clinically significant prostate cancer. The American Urological Association (AUA) says it may be useful in men with an elevated PSA as a secondary test. “Cutting back on use of DRE for screening purposes could be good news for many. The discomfort and embarrassment associated with the exam might deter some men from being tested for prostate cancer.

“So while PSA testing guidelines vary, you can feel comfortable that the US Preventive Services Task Force, the AUA, and the American Cancer Society all do not require the DRE for primary screening for prostate cancer.” Having practised intermittently in different jurisdictions in the US for well over four decades, I am well aware that the discussions in that country and other so-called First World countries have revolved around criteria to be used in the interpretation of a PSA test and ways to proceed if the test is deemed to be significant.

To persuade men to go and face the “dreaded finger” disappeared from the literature more than two decades ago and should not be encouraged for the reason stated in the second paragraph of the article (above).

I await the TT Urological Association position on this.

Kenwyn Nicholls, MD, MPH via e-mail