Summary of Digital Rectal Exams Are NOT Useful To Early Detect Prostate Cancers:
The digital rectal exam (DRE) may not be an accurate enough screening tool for detecting prostate cancer, according to researchers at the German Cancer Research Center. The DRE is widely used as an initial check for the signs of prostate cancer in men, but the researchers suggest the technique may be missing many cancers in their early stages. As a result, they are calling for other testing methods, such as prostate-specific antigen (PSA) testing and MRI scans, to be used in routine screening instead of or in addition to the DRE. The researchers believe this will lead to better outcomes from treatment by detecting cancers earlier.
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Prostate Cancer Screening: Is Digital Rectal Exam Enough?
Prostate cancer is one of the most common forms of cancer among men worldwide, and detecting it in its early stages is essential for optimal treatment and better health outcomes. However, researchers are now warning that the traditional method of detecting prostate cancer through the digital rectal examination (DRE) may not be accurate enough as a reliable screening tool by itself.
The DRE is a standard medical practice used widely to identify the signs of prostate cancer in men. During the exam, the physician inserts a gloved and lubricated finger into the rectum to feel for any unusual swelling or lumps in the prostate gland. While it has been widely used to detect prostate cancer for years, new research suggests that the DRE may be missing many cancers in their early stages. The findings have implications for prostate cancer screening and early detection.
The PROBASE Trial
Scientists of the PROBASE trial coordinated at the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) in Heidelberg led the research that could influence prostate cancer screening. The PROBASE trial is a multicenter German prostate cancer screening study involving 46,495 men of 45 years and above who were enrolled between 2014 and 2019. The trial involved four universities, namely TU Munich, Hannover, Heidelberg, and Düsseldorf. The men have since undergone follow-ups to assess their health in the years after screening. Half of the participants in the trial were offered a prostate-specific antigen (PSA) blood test at age 45 while the other half underwent the digital rectal examination with delayed PSA screening at age 50.
The researchers discovered that the digital rectal exam method had too low a detection rate and was missing too many early-stage cancers. Ultimately, only 6,537 men underwent DRE in the delayed screening group, and only 57 of those were referred for follow-up biopsy due to suspicious findings. Out of the 57 referrals, only three were found to have cancer. Contrastingly, the PSA testing at the age of 45 detected four times more prostate cancers.
Why the DRE Might Not Detect All Cancers
According to Professor Peter Albers, a urologist at Düsseldorf University and the senior author of the study, the DRE is not sensitive enough to detect prostate cancer in younger men. The researchers believe that the changes in the tissue in the prostate may be too slight to detect with a finger, and some cancer may occur in a part of the prostate that cannot be easily reached by a finger.
“Early-stage cancer may not have the size and stiffness to be palpable,” Professor Albers explained. A separate analysis that used MRI scans before biopsies to locate cancers in the prostate found that about 80% of the detected cancers were in an area that should be easy to reach with a finger, yet cancers were not detectable with the DRE.
Implications of the Findings
The findings of the PROBASE trial suggest that while the DRE is a common method of detecting prostate cancer, it’s not accurate enough to be used solely as a reliable screening tool. The researchers are recommending other testing methods, such as PSA tests and MRI scans, to be used in routine screening instead.
Dr. Agne Krilaviciute, a researcher at DKFZ and the lead author of the study, stated that the aim of screening for prostate cancer is to detect it as early as possible, as this can lead to better outcomes from treatment. However, their study reveals that the digital rectal exam is not useful enough to detect early-stage cancers.
Professor Albers added 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. Men are probably put off since the examination puts them through discomfort, and the participation rate is less than 20% in the screening program for men aged 45 to 50 years in Germany.
Conclusion
Prostate cancer is a significant health concern among men globally, and early detection plays a critical role in better health outcomes. However, the traditional method of detecting prostate cancer through the digital rectal exam has been found to be inaccurate to be used solely as a reliable screening tool.
The PROBASE trial researchers have recommended using other screening tests such as PSA tests and MRI scans to complement the digital rectal exam. This study opens up new pathways for prostate cancer screening and treatment, and it’s essential to consider the potential implications of these new findings for the screening program for prostate cancer in your country.
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