There has been some debate about whether it is still necessary to use the digital rectal exam in prostate cancer screening.

Our recent study, (Catalona and Okotie) shows that a significant proportion of patients whose cancers are detected by the rectal exam definitely benefit from surgery and have poor pathology outcomes that put them at risk for tumor spread.

In our study, of the 569 men with Gleason grade 7 or above, 10% were detected by DRE alone.

Ten-year recurrence-free survival for those patients diagnosed by DRE only was 86%, for those by PSA only was 87% and those diagnosed by abnormalities in both DRE and PSA was 78%.

Many tumors detected by DRE only are potentially curable, but may no longer be by the time the PSA also reaches the biopsy threshold.

Taking the DRE from screening practices can seriously compromise treatment outcomes.