Digital Rectal Exams for Routine Prostate Screening Discouraged

By Joe Elia

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Digital rectal examination (DRE) for prostate cancer screening in primary care should be discouraged given "the lack of evidence supporting its use," according to a meta-analysis.

The analysis encompassed seven studies measuring the effectiveness of DRE in screening for prostate cancer in primary care settings. The studies included some 9000 patients who underwent a DRE by primary care clinicians and, based on the results, a subsequent biopsy. The studies showed a high risk for bias, and the overall quality of evidence was rated as "very low."

From the studies' pooled results, DRE's sensitivity was estimated to be 0.51, with a specificity of 0.59 and a positive predictive value of 0.41.

Writing in the Annals of Family Medicine, the researchers say they "do not recommend routine screening ... using DRE in primary care," given the risks for overdiagnosis and overtreatment.