Study Questions Benefit of Digital Rectal Exams in Early Prostate Cancer Detection

There has been recent and ongoing debate about the value early prostate cancer screenings offer for men who do not have an increased risk for the disease.   Most recently, Canadian family doctor Jason Profetto has analyzed data that brings into question the benefit of annual digital rectal examination for men over the age of 40 or 50.  His research included more than 9,000 patients and although the test may be helpful for issues of rectal bleeding, masses or enlarged prostate,  there was no evidence that routine rectal exams are a good tool for prostate cancer screening before symptoms are noticed.

Family doctors often still perform digital rectal exams but many recent medical school graduates have never performed one and according to a CBCNews report, a survey of Canadian medical schools indicated that only half of primary care doctors feel they have the skills necessary to detect prostate cancer with a digital exam.   

Although the Canadian Urological Association still recommends digital exams and blood screening test for men over 50 with an average risk who are expected to live another 10 years, the U.S. Preventative Services Task Force recommends men ages 55 to 69 should “make an individualized decision about prostate cancer screening” with their doctor.   Men older than 70 are not advised to undergo PSA screening.  Over-diagnosis and invasive treatment including surgery and radiation are linked with incontinence and erectile dysfunction.  Many prostate cancers are slow-growing and false positive PSA test results can sometimes lead to aggressive treatments causing more harm than benefit.

With drawbacks to both screenings traditionally used to detect prostate cancer early, it’s difficult to know what is the best approach to take.  The most current recommendation is talking with your physician about individual risk factors to determine what screening are appropriate.

Risk Factors

• Age – risk increases with age
• Race – black men carry a greater risk are more likely to have advanced or aggressive prostate cancer
• Family History – a family history of prostate cancer or a family history of genes that increase the risk for breast cancer may increase risk
• Obesity – obese men are more likely to have advanced disease that is more difficult to treat

Prostate cancer may have no symptoms in the early states

Signs of more advanced prostate cancer include:

• Trouble urinating
• Decreased force in the stream of urine
• Blood in semen
• Discomfort in the pelvic area
• Bone pain
• Erectile dysfunction

Source:  Mayo Clinic