rectal exams using finger ‘not useful’ for detecting prostate cancer, study says
not only is a psa (prostate specific antigen) blood test more effective, it may also encourage more men to be screened for prostate cancer, according to researchers.
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a new study has found that digital rectal exams (dre), a procedure commonly used to detect prostate cancer, may not be sensitive enough to detect the disease in its early stages.
according to the research, which was presented at the european association of urology annual congress in milan, using a finger to detect the presence of unusual swelling or lumps on the prostate may be doing a disservice to the health of young men. in germany, where the study was conducted, a dre is the only method currently used by the country’s national screening program.
“one of the main reasons for screening for prostate cancer is to detect it in patients as early as possible as this can lead to better outcomes from treatment,” said agne krilaviciute, lead author of the study and a researcher at the german cancer research centre (dkfz). “but our study suggests that the dre is simply not sensitive enough to detect those early stage cancers.”
prostate irregularities may not be detected with a finger
the researcher is part of the probase trial, a multi-centre german prostate cancer screening study that includes 46,495 men over the age of 45 who were enrolled between 2014 and 2019. half of the men in the trial were offered a prostate specific antigen (psa) blood test at age 45 while the other half were offered a dre to be followed by delayed psa screening when they turned 50. all participants had their health evaluated in the years following their initial screening.
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of the 6,537 men who were given a dre, 57 had suspicious findings that required referral for biopsy. only three were eventually found to have cancer. the detection rate was considerably higher when a psa was used for initial screening.
“the dre was giving a negative result in 99 per cent of cases and even those that were deemed to be suspicious had a low detection rate,” krilaviciute said. “results we’ve seen from the probase trial show that psa testing at the age of 45 detected four times more prostate cancers.”
according to the team, digital rectal exams may be falling short because the tissue in the prostate, particularly in young men, may be too slight for detection by a finger. also, depending on the part of the prostate affected, evidence of the disease may simply be hard to reach.
“early stage cancer may not have the size and stiffness to be palpable,” said peter albers, senior author of the study and a urologist at düsseldorf university. “separate analysis that used mri scans before biopsies to locate cancers in the prostate showed that about 80 per cent of these are in an area that should be easy to reach with a finger and still cancers were not detectable by dre.”
psa and mri may be a more effective screening protocol
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prostate cancer is the fourth most common cancer in canada — and number one among men — with an estimated 24,600 people receiving a diagnosis in 2022, according to the canadian cancer society. around 4,600 men were expected to have succumbed to the disease last year. eight provinces and three territories cover the cost of the psa test by referral without requiring symptoms, except ontario and british columbia.
the team hopes the glaring discrepancy in detection methods will encourage screening programs use a combination of psa testing and mri scans instead of dre. the switch may be appealing to men for other reasons.
“if the aim of a screening program is to pick up cancers as early as possible and the current screening tool isn’t doing that job, then that is a fundamental failure of that approach,” albers said. “we speculate in our paper that not only is the dre not useful for detecting cancer but it may also be one reason why people don’t come to screening visits — the examination probably puts a lot of men off.
“in germany, for example, the participation rate is less than 20 per cent in the screening program for men 45 to 50 years. if we were to offer psa testing instead, more of them might be willing to come.”
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dave yasvinski is a writer with healthing.ca
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