Rectal examinations aren’t good at catching prostate cancer early. Here’s what is.

The new study, presented last week at a major European congress, demonstrated that using digital rectal exams (DRE) alone would cause doctors to miss cases of prostate cancer. Meaning some men might be missing out on an early diagnosis and the chance of a cure.

Mention ‘prostate checks’ and the common response is jokes involving the doctor putting a finger up the backside. However, in the UK, in the first instance men have a PSA blood test to check for prostate cancer. In some cases, a DRE can provide information to help doctors decide if further tests are needed, but it isn’t routinely used.

Of the 46,495 men aged 45 that took part in the Probase trial, half were given a PSA blood test while the other half were initially given a DRE followed by a PSA blood test five years later. Results found that the DRE alone was not sensitive enough to be used for screening, with the PSA blood test detecting four times more cases of prostate cancer.

Overall, using DRE alone gave a negative result 99% of the time and wasn’t an accurate test even in suspicious cases. Shockingly, a separate analysis showed that around 80% of the cancers were in areas of the prostate that should be easy to reach with a finger, but still these cancers were not caught.

What is a DRE? What should I do if I am offered one?

A DRE involves a doctor or nurse feeling the prostate through the walls of the back passage to check for swelling or lumps that may indicate cancer.

As this study has shown, the DRE alone is not an effective test for prostate cancer. A doctor or nurse can’t feel the whole prostate. And a man with prostate cancer might have a prostate that feels normal or have slight changes that may be difficult to detect with a finger.

It’s natural for some men to find the DRE uncomfortable or embarrassing, and it can also be upsetting for anyone that has been sexually abused.

Some men are given rectal checks as they can be useful to help understand what may be causing certain symptoms (e.g. an enlarged prostate can cause urinary problems). The test isn’t painful, and it doesn’t take long. You can ask your GP if you would like to have someone there for support, for example your partner, a friend or a chaperone. You don’t have to have a DRE. You can talk to your doctor and decide to only have a PSA blood test.

We need a screening programme so all men have an equal chance of an early diagnosis

Amy Rylance, Head of Improving Care at Prostate Cancer UK, said: “This research backs up existing evidence that digital rectal exams are not the most effective way to diagnose prostate cancer. The good news is that standard practice on the NHS is that men have a PSA blood test in the first instance, followed by an MRI scan. Whilst the DRE can sometimes add useful information that might help doctors with their clinical decision making, it is no longer routinely done.”

For 26 years we’ve been making improvements to the diagnostic pathway. Before 2019, men with a high level of PSA in their blood were sent straight for a biopsy, which could cause anxiety, uncomfortable side effects and infection. These biopsies could also sometimes miss the cancer.

We helped to fund research that showed having mpMRI scans beforehand could safely avoid unnecessary biopsies, and improve the accuracy of those that were needed. We also worked closely with the NHS to make sure the innovative technique was rolled out across the country, decreasing the number of unnecessary biopsies by 64 per cent.

The widespread adoption of these techniques, funded by you, can potentially prevent tens of thousands of men each year from facing unnecessary harms during screening, meaning the benefits may now outweigh the drawbacks. Research we published last month shows the UK may finally be ready for prostate cancer screening.

“There is currently no screening programme for prostate cancer,” said Amy Rylance. “This is why Prostate Cancer UK is committed to driving the research and evidence required to make this a reality and save thousands of men’s lives. Until then, higher risk men have the right to ask for a PSA blood test for free from their GP – to understand if you’re at higher risk do the Prostate Cancer UK 30-second online risk checker.”

Thanks to your ongoing support, we’re improving diagnosis for men everywhere. Every donation gets us one step closer to a screening programme for prostate cancer.

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