What is the role of a digital rectal exam (DRE) in prostate cancer screening?

Updated: Jan 14, 2019
  • Author: Lanna Cheuck, DO; Chief Editor: Edward David Kim, MD, FACS  more...
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DREs are examiner dependent, and serial examinations are best. Various factors are considered when a DRE is performed. A nodule is important, but findings such as asymmetry, difference in texture, and bogginess are important clues to the patient's condition and should be considered in conjunction with the PSA level. Change in texture over time can offer important clues about the need for intervention.

Pay careful attention to the prostate’s consistency, along with the seminal vesicles and adjacent organs. Such observation can be help to detect the disease’s spread to other structures, the results of which can be as follows:

  • Overdistention of the bladder due to outlet obstruction
  • Lower extremity lymphedema
  • Supraclavicular adenopathy
  • Lower extremity deep venous thrombosis
  • Cancer cachexia
  • Neurologic findings secondary to cord compression - Other subtle neurologic findings, such as paresthesias or wasting, are uncommon

Cysts and stones cannot be accurately differentiated from cancer based on DRE findings alone; therefore, maintain a high index of suspicion if the DRE results are abnormal.

If cancer is detected, the DRE findings form the basis of clinical staging of the primary tumor using the TNM staging system.

In most patients who are diagnosed with prostate cancer, however, the DRE results are normal and the PSA readings are abnormal.

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