Digital rectal examination not useful for screening prostate cancer in young men

In Germany, For screening of PCa, Annual DRE is recommended as a stand-alone screening test in 45+ yr olds. The diagnostic performance of DRE in men as young as 45 is not proved by a screening trial. The main objective of the present study is to determine DRE diagnostic performance in analysis conducted within the multicentric, randomized PROBASE trial.

The study enrolled > 46,000 men at age 45 to test risk-adapted prostate-specific antigen (PSA) screening for PCa. The intervention included DRE analyses as a one-time, stand-alone screening offer at age 45 in 6537 men in one arm of the trial and evaluation of PCa detection by DRE at the time of PSA-screen–driven biopsies (N = 578).

The Outcome measurements and statistical analysis included True-/false-positive detection rates of DRE than PSA screening and evaluation of DRE outcome at the time of a prostate biopsy.

The key findings of the study are:

• A prospective analysis of 57 men with suspicious DRE at age 45 revealed three PCa.
• The rate of Detection by DRE was 0.05% (three of 6537) compared to a four-fold higher rate by PSA screening (48 /23 301, 0.21%).
• The true-positive detection rate by DRE relative to screening by PSA was 0.22.
• The false-positive detection rate by DRE was 2.2.
• Among PSA-screen–detected PCa cases, 86% had unsuspicious DRE. The sensitivity relative to PSA was 14%.
• 86 % of these tumours were located in the potentially accessible zones of the prostate, as seen by MRI.

Researchers from the German Cancer Research Center said, “In our study, we found that performance of stand-alone DRE for Prostate cancer screening is poor.”

They mentioned in young men, DRE should not be recommended as a PCa screening test. Furthermore, DRE does not improve the detection of PSA-screen–detected PCa.

Reference:

Krilavičiūtė, A., Becker, N., Lakes, J., Radtke, J. P., Kuczyk, M. A., Peters, I., Harke, N., Debus, J., Koerber, S. A., Herkommer, K., Gschwend, J. E., Meissner, V. H., Benner, A., Seibold, P., Kristiansen, G., Hadaschik, B., Arsov, C., Schimmöller, L., Giesel, F. L., . . . Albers, P. (2023). Digital rectal examination is not a useful screening test for prostate cancer. European Urology Oncology. https://doi.org/10.1016/j.euo.2023.09.008