A new study has found that digital rectal examination (DRE), either alone or in conjunction with a blood test, does not improve prostate cancer detection compared to the blood test alone. The results suggest that DREs may be less effective than previously thought and could be omitted during prostate cancer screening in men who do not have clinical symptoms.
Screening methods for prostate cancer typically involve digital rectal examination (DRE) and a blood test to measure prostate-specific antigen (PSA) levels. PSA is a protein produced by both cancerous and noncancerous prostate tissue, so elevated levels may indicate either cancer or benign prostatic enlargement. DRE does not require further explanation and is often used in conjunction with PSA as a diagnostic tool.
Is one method better than the other in detecting prostate cancer, or are both necessary? A new study conducted by researchers from the Comprehensive Cancer Center at the Medical University of Vienna (MedUni Vienna) and the Vienna General Hospital may provide an answer to this question.
The researchers conducted a meta-analysis of eight studies involving 85,738 individuals aged 45 to 98, of which three were randomized controlled trials and five were prospective diagnostic studies. The qualifying studies evaluated men undergoing prostate cancer screening using DRE as the screening method compared to PSA testing to assess the diagnostic effectiveness of these methods based on prognostic value and cancer detection rates.
The data suggest that combining DRE and PSA in prostate cancer screening does not provide significant benefits compared to PSA testing alone in predicting and detecting cancer. While the results did not show a significant difference in prognostic value between DRE and PSA, PSA demonstrated a significantly higher cancer detection rate than DRE.
“The reliability of DRE in detecting prostate cancer is not impressive, suggesting that it may not be necessary to routinely perform this examination as part of screening if there are no clinical symptoms,” said Shahrokh Shariat, corresponding author of the study.
DRE is a highly subjective test, compromising its effectiveness as a screening method. A study from 2008 found that the percentage of suspicious DREs varied depending on the examiner, ranging from 4% to 28%. Analyzing studies that included alternative screening and detection methods, especially one that showed a significantly higher cancer detection rate for magnetic resonance imaging (MRI) (63%) compared to PSA (29%), researchers suggest that MRI and PSA should replace the combination of DRE and PSA.
This study opens up a discussion about the effectiveness and benefits of DRE in early prostate cancer detection. Considering that the cost of PSA testing is low and DRE causes physical discomfort and psychological stress to patients, these data indicate that PSA testing appears to be a more effective and less burdensome screening test than DRE, according to researchers. They also point to the reluctance to undergo DRE as one of the reasons why men often avoid prostate cancer screening, which may increase their risk.
“Continuously improving prostate cancer screening methods is of paramount importance for the health and well-being of men worldwide,” said Shariat. “We hope that by eliminating this barrier, more men will undergo prostate cancer screening.”
The study was published in the European Urology Oncology journal.
Source: MedUni Vienna
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