The Human Touch: Digital Rectal Exams Still Gold Standard In Prostate Cancer Detection
By Jonathan Weiss
Despite the availability of new high-tech methods to detect prostate cancer, the actual examination of the prostate by the doctor seemed to best match the diagnosis of cancer after biopsies.
PSA is a protein that is present in the blood of all men at low levels. Yet the presence of prostate cancer raises the level which can be detectable by standard laboratory tests. But the test does not catch all instances of prostate cancer and relying solely the lab tests could discount a time tested prostate cancer test, the digital exam.
The digital prostate exam is a procedure where a doctor feels the surface of the prostate with gloved fingers and detects any bumps or hard sections on the prostate surface.
"Prostate cancer is the most common cancer in men, accounting for over 28,000 deaths yearly," said Dr. Jay Raman, associate professor of surgery. "Improvements in screening methodology and refinements in cancer care have contributed, in part, to a reduction in recent mortality rates."
In a current study a group from Penn State University studied 806 men during the years between September 2001 and December 2008 to compare the PSA test with the digital exam.
Of the men tested half had an elevated PSA level and 36 percent had an abnormal digital exam. Biopsy diagnosed 306 of the men as having prostate cancer, and of that group 136 of the men did indeed have abnormal results from the digital exam.
Importantly, 43 of the 136 men who had an abnormal digital rectal exam who had prostate cancer did not have elevated levels of PSA. In total 14 percent of all the patients with prostate cancer had an abnormal rectal exam, only 31 percent of them had normal PSA levels.
"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.
The research was published in the Canadian Journal of Urology and can be found here.