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Rapid response to:

Views & Reviews From the Frontline

Bad medicine: digital rectal examination

BMJ 2011; 342 doi: (Published 01 June 2011) Cite this as: BMJ 2011;342:d3421

Rapid Response:

DRE is useless for follow up of prostate cancer patients

Certainly from the prostate cancer point of view, I have to agree
with Des Spence. With increasing use of PSA (prostate specific antigen), I
agree that the role of DRE as a prostate cancer screening tool is almost

As regards DRE as a follow up tool, in prostate cancer patients
treated by radiotherapy, a Royal Marsden study found that DRE fails to
detect any local recurrences in the absence of a rising PSA (1).

Similarly, a literature review found that after prostatectomy a PSA
increase reliably preceded disease recurrence, making digital rectal
examination superfluous to requirements (2).

Further more, results of DRE could be inconsistent. A study from San
Antonio found that approximately 70% of abnormal DREs were normal the
following year even in patients with prostate cancer (3).

Evidence, not dogma, should guide our Clinical practice.


1. Doneux A, Parker CC, Norman A, Eeles R, Howich A, Huddart R,
Dearnaley D. The utility of digital rectal examination after radical
radiotherapy for prostate cancer. CLINICAL ONCOLOGY, 2005: 17 (3). pp. 172

2. Katherine S. Warren, a, and Jonathan P. McFarlanea . Is Routine
Digital Rectal Examination Required for the Followup of Prostate Cancer?
The Journal of Urology Volume 178, Issue 1, July 2007, Pages 115-119

3. Donna Pauler Ankersta, b,, Ryan Miyamotoa, Prakash Vijay Nairb,
Brad H. Pollockb, Ian M. Thompsona,and Dipen J. Parekha. Yearly Prostate
Specific Antigen and Digital Rectal Examination Fluctuations in a Screened
Population. The Journal of Urology. Volume 181, Issue 5, May 2009, Pages

Competing interests: No competing interests

13 June 2011
Santhanam Sundar
Consultant Oncologist
Nottingham University Hospital NHS trust, Nottingham NG5 1PB