March 9, 2023 – Every now and then, new research comes along that questions the normal standard of care in medicine. In this case, a study out of Germany raises a concern about the value of digital rectal examinations for detecting prostate cancer, particularly in its early stages. 

Investigators enrolled 46,495 men screened for prostate cancer at age 45 in the PROBASE trial between 2014 and 2019. Half of the men were offered a digital rectal exam, or DRE, where a health care professional uses a finger to check their prostate gland for any lumps or unusual swelling, followed by a prostate-specific antigen blood test 5 years later at age 50. The other half were offered only the PSA test at age 45.

Lead investigator Agne Krilaviciute, PhD, and colleagues found the PSA test detected four times as many cases of early prostate cancer as a digital rectal exam alone.

“One of the main reasons for screening for prostate cancer is to detect it in patients as early as possible,” Krilaviciute, a researcher at the German Cancer Research Center, Deutsches Krebsforschungszentrum, in Heidelberg, said in a news release. “Our study suggests that the DRE is simply not sensitive enough to detect those early stage cancers.”

The researchers suggest other tools be used to screen men for prostate cancer, such as PSA testing and MRI scans, instead of digital rectal exams. The findings were presented at the European Association of Urology Annual Congress in Milan. 

Of the 23,194 people enrolled in the delayed PSA group, 6,537 had a rectal exam. Within this group, 57 had suspicious findings and had a biopsy. Three of them were diagnosed with prostate cancer. 

“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,” Krilaviciute said. “In Germany, for example, the participation rate is less than 20% in the screening program for men 45 to 50 years. If we were to offer PSA testing instead, more of them might be willing to come.”