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Views & Reviews From the Frontline

Bad medicine: digital rectal examination

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3421 (Published 01 June 2011) Cite this as: BMJ 2011;342:d3421

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
obsolete.

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.

References:

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
-173.

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
2071-2076

Competing interests: No competing interests

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