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

Last edited 04/2019 and last reviewed 07/2022

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:

• 1. Prostate Cancer Risk Management Programme Information for primary care; PSA testing in asymptomatic men. Evidence document. NHS Cancer Screening Programmes, 2010
• 2. Wilbur J. Prostate cancer screening: the continuing controversy. Am Fam Physician. 2008;78(12):1377-84
• 3. Jones D et al. The diagnostic test accuracy of rectal examination for prostate cancer diagnosis in symptomatic patients: a systematic review.BMC Fam Pract. 2018 Jun 2;19(1):79