Prostate Cancer UK and the British Association of Urological Surgeons want to move away from using digital rectal exams to detect prostate cancer.

Prostate Cancer UK and the British Association of Urological Surgeons (BAUS) are advising GPs that men with suspected prostate cancer don’t need to have a rectal exam before being referred for further tests.

Men should instead be referred for an MRI scan which, they argue, will give a more accurate indication of whether they have cancer.

Although the digital rectal examination has historically been considered a standard test, the information a GP can get from a rectal exam is of extremely limited value. The digital rectal examination only enables the clinician to feel the back wall of a man’s prostate, and most prostate cancer develops on the front wall of the gland, where it cannot be felt.

“Digital rectal examination, or DRE, has long been a part of how we assess prostate health, but the truth is, with modern tools like Prostate Specific Antigen (PSA) blood tests and MRI scans offering far more accurate insight, the DRE is increasingly redundant in prostate cancer diagnosis,” said Vishwanath Hanchanale, chair of oncology at BAUS. 

“In practice, many men referred with abnormal DREs are found to have normal results when assessed by urology specialists,” he continued. 

Digital rectal examination

In a recent survey of men for Prostate Cancer UK, around 750 men said that they had asked their GP for a PSA blood test. A third of these men were offered a rectal exam as well as a blood and only 3% were offered the exam instead of a blood test.

The Royal College of GPs has, however, sounded caution. 

Chair of the college Kamila Hawthorne argued that the PSA test alone is not reliable enough to detect prostate cancer that needs treatment as it has a false negative rate of about 15%, which means some cases can fall through the gaps.

“If a patient has a negative PSA test result but their GP is still concerned about their symptoms, then a digital rectal examination can help to identify potential prostate cancer. With the Transform Trial underway, it is sensible to wait for the evidence to become available before we change current clinical practice and move away from DRE altogether,” she said. 

Prostate Cancer UK launched its £42 million Transform Trial in May, the largest prostate cancer screening trial for 20 years. It plans to compare the most promising tests and provide definitive evidence about the best way to screen for prostate cancer.