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On call: The digital rectal exam

December 01, 2009

Q. I just reviewed your article on PSA testing. After talking with my wife, I've decided to skip the PSA test when I go for my annual physical next month. But your article doesn't say much about rectal exams. Should I skip that also?

A. It's a good question. We didn't have much to say about the digital rectal exam (DRE) because we were focusing on studies that don't tell us much about the DRE. The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial tested the combination of prostate-specific antigen (PSA) and DRE and found that the pair did not reduce the risk of dying from prostate cancer. The European Randomized Study of Screening for Prostate Cancer (ERSPC) was conducted in seven countries; all used the PSA, but only a few added DREs — and even these included DREs for just a portion of the nine-year trial. As you may recall, the ERSPC found that screening reduced prostate cancer deaths by 20%, but at the cost of treating 48 men unnecessarily to prevent one prostate cancer death.

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