Digital rectal exam remains important part of prostate screening

March 18, 2013, Pennsylvania State University

(Medical Xpress)—The digital rectal exam is an important screening test that can discover prostate cancer that a prostate-specific antigen or PSA test may not, despite the higher sensitivity of the PSA test, according to Penn State College of Medicine researchers.

The digital rectal examination is a procedure where a physician feels the surface of the prostate with a gloved finger. The doctor is able to feel any lumps or hard areas on the prostate.

A checks for levels of prostate-specific antigen in the blood, with higher levels signaling potential cancer. As men age, the acceptable PSA level increases.

"Prostate cancer is the most common cancer in men, accounting for over 28,000 deaths yearly," said Jay Raman, M.D., associate professor of surgery. "Improvements in screening methodology and refinements in have contributed, in part, to a reduction in recent ."

An elevated PSA level or an abnormality found on the prostate during the typically leads to the recommendation of prostate needle biopsy, the most accurate . Elevated have been shown to more accurately predict a positive cancer biopsy result than the rectal exam. The digital rectal exam has been considered less precise because of the variability in of who is administersing the test and the experience of that person, and the incorrect positives associated with noncancerous abnormalities.

Other studies have shown the PSA test to be more sensitive and specific than the digital rectal exam, especially at low PSA levels. However, no study to the researchers' knowledge has looked at the effectiveness of the digital rectal exam when compared to age-adjusted PSA levels.

Penn State Hershey researchers studied 806 men from September 2001 to December 2008 to see how the initial testing lined up with the results of their biopsies.

In the group of men studied, half had elevated PSA levels and 36 percent had an abnormal digital rectal exam (with or without an elevated PSA). The diagnosed 306 of the men as having prostate cancer. Of that number, 136 of the men had an abnormal digital rectal exam finding.

Most importantly, 43 of the 136 men who had an abnormal digital rectal exam showed a normal PSA level for their age. While 14 percent of all patients with prostate cancer had an abnormal digital rectal exam, 31 percent of these men had normal PSA levels for their age.

"It is important to acknowledge that age-specific PSA cutoffs contribute some limitations in prostate cancer screening," Raman said. "In particular, while age-specific thresholds increase the sensitivity in younger men, these same cutoff values lower the sensitivity in older men."

Because the acceptable PSA level is increased for older men, it is possible that is being missed if only the PSA test is used.

"Our study confirms that the digital rectal exam remains an important part of screening such patients because 31 percent of cancers in our study would have been missed by using age-specific PSA cutoffs alone," Raman said.

Researchers published their findings in The Canadian Journal of Urology.

Explore further: Rectal exams may benefit obese men more than normal-weight peers

Related Stories

Rectal exams may benefit obese men more than normal-weight peers

July 11, 2011
An occasional nuisance men endure to check for prostate cancer, the digital rectal exam may have heightened importance for those who are obese.

Change in PSA levels over time can help predict aggressive prostate cancer

January 15, 2013
Measurements taken over time of prostate specific antigen, the most commonly used screening test for prostate cancer in men, improve the accuracy of aggressive prostate cancer detection when compared to a single measurement ...

PSA test for men could get a second life for breast cancer in women

July 13, 2011
The widely known PSA blood test for prostate cancer in men may get a second life as a much-needed new test for breast cancer, the most common form of cancer in women worldwide, scientists are reporting in a new study in the ...

New prostate cancer test gives more accurate diagnosis

April 6, 2011
In a large multi-center clinical trial, a new PSA test to screen for prostate cancer more accurately identified men with prostate cancer -- particularly the aggressive form of the disease -- and substantially reduced false ...

Recommended for you

How cancer metastasis happens: Researchers reveal a key mechanism

January 18, 2018
Cancer metastasis, the migration of cells from a primary tumor to form distant tumors in the body, can be triggered by a chronic leakage of DNA within tumor cells, according to a team led by Weill Cornell Medicine and Memorial ...

Modular gene enhancer promotes leukemia and regulates effectiveness of chemotherapy

January 18, 2018
Every day, billions of new blood cells are generated in the bone marrow. The gene Myc is known to play an important role in this process, and is also known to play a role in cancer. Scientists from the German Cancer Research ...

These foods may up your odds for colon cancer

January 18, 2018
(HealthDay)—Chowing down on red meat, white bread and sugar-laden drinks might increase your long-term risk of colon cancer, a new study suggests.

The pill lowers ovarian cancer risk, even for smokers

January 18, 2018
(HealthDay)—It's known that use of the birth control pill is tied to lower odds for ovarian cancer, but new research shows the benefit extends to smokers or women who are obese.

Researchers develop swallowable test to detect pre-cancerous Barrett's esophagus

January 17, 2018
Investigators at Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center have developed a simple, swallowable test for early detection of Barrett's esophagus that offers promise ...

Scientists zoom in to watch DNA code being read

January 17, 2018
Scientists have unveiled incredible images of how the DNA code is read and interpreted—revealing new detail about one of the fundamental processes of life.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.