Macro study once again casts doubt on digital rectal examination for detecting prostate cancer

The prostate is the male gland responsible for secreting the fluid that makes up sperm, and cancer is one of the two main diseases it can suffer from, especially after age 60. Interestingly, the two main early detection tests have been questioned for more than a decade, which has led experts to refine their use by establishing very precise medical criteria. If prostate cancer is not looked for using a protein called PSA or rectal examinations are not performed, what tools do urologists have to detect or check a man’s health in time? In fact they are. Ultrasound is an option, but they say the results alone will not be sufficient to make an informed clinical judgment.

The latest work questioning the value of digital rectal examination is actually a meta-analysis combining data from eight large international studies involving 85,738 patients. The study, signed by the Comprehensive Cancer Center Vienna, affiliated with the central European city’s university, suggests that looking for prostate abnormalities using the middle and index fingers is no more effective than a PSA test, either alone or in combination with it. . .

Urologists need tools

For this reason, the report’s authors conclude that digital rectal examination “may not be as effective as expected in the routine detection of prostate cancer, especially in the absence of specific symptoms or signs.” The head of the Department of Urology at MedUni Vienna, who led the study, bluntly stated that “the reliability of this examination is not particularly impressive, suggesting that it may not be necessary to perform it routinely as part of screening in the absence of symptoms.” or signs.” doctors.

The main symptoms of prostate cancer are, among other things, difficulty urinating, sometimes with pain, even burning; weak urine flow; Frequent urination, especially at night, and a feeling that the bladder remains full no matter how many times the person goes to the toilet. The dilemma facing urologists is that prostate cancer, very common but rarely fatal, is very difficult to diagnose and the tests used to detect it are not entirely effective.

The main one is the detection in the blood of that protein PSA (prostate-specific antigen), which changes and multiplies more easily when a tumor disease appears. But this indicator presents two difficulties. First, its greater presence in the bloodstream may also be due to benign prostate disease (prostatitis), a typical age-related increase that requires other specific treatment. Prostate manipulation also promotes greater proliferation of PSA proteins. To make matters worse, the test produces a high rate of false positive results, requiring multiple punctures of the patient’s prostate with the subsequent risk of developing urinary and fecal incontinence and impotence.

Expert hands

They try to compensate for the shortcomings of this analysis with two other tests. Ultrasound helps, but the images it produces are also not specific for cancer. The third is the rectal examination, which is also used to look for a benign disease, but again and again is under the shadow of suspicion. “From age 60, and especially from age 65, rectal examination should become part of routine examinations by urologists,” advocates Chantada Abal. “I wouldn’t downplay it or advocate that it applies to everyone, but there is a small group of patients with very aggressive cancer who don’t produce PSA. Only the hands of an experienced urologist will be able to detect it in time and begin treatment if it is considered necessary. Find out more from an expert. “It still saves lives,” he emphasizes.

One criticism often leveled against this practice is that the examiner’s fingers do not allow the entire prostate to be palpated. There will always be some area beyond your control where the tumor you are looking for may be nesting. “Only by palpating can we check its size and consistency. Examination of the gland and finding nothing can be very reassuring to the patient, who, incidentally and logically, is always asked if he wants to undergo a rectal examination. The decision is yours,” emphasizes the expert of the Spanish Association of Urology.