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Digital rectal examination (DRE) and screening or diagnosis for prostate cancer

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Digital rectal examination (DRE) should be offered to men with lower urinary tract symptoms or symptoms suggestive of metastatic disease (1).

DRE can be used to detect:

  • the prostate for signs of prostate cancer - a hard gland, sometimes with palpable nodules
  • benign enlargement - smooth, firm, enlarged gland (1)

Symmetric enlargement is a common finding in aging men (2). A gland which feels normal in DRE does not exclude a tumour (1)

The effectiveness of DRE in detecting prostate cancer is not well established

  • estimated sensitivity is fairly poor (53% to 59%) while the specificity is better (83% to 94%)
  • many early prostate cancers will not be detected by DRE (1)
  • studies have shown that in patients who had a biopsy done based on DRE findings, 72% to 82% of will not have prostate cancer
  • in addition, around quarter of patients who had prostate cancers detected with biopsy after abnormal DRE findings, prostate cancer was found in a different area than to the DRE findings (2).

DRE is not recommended as a screening test in asymptomatic men (1)

A single study with symptomatic men showed (3):

  • sensitivity and specificity for DRE as a predictor of prostate cancer in symptomatic patients was 28.6 and 90.7%, respectively. The positive and negative predictive values were 42.3 and 84.2%, respectively.

Reference:


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