Finger rectal exams have always been part of annual checks for men to screen for prostate cancer but now researchers are questioning the method's value. Is it time to abandon it?
According to a study published in the journal Current Medical Research and Opinion, it depends on the situation but most cases support the use of more modern methods of screening for prostate cancer.
"Our findings will likely be welcomed by patients and doctors alike," said Dr. Ryan Terlecki, one of the study's authors.
As the oldest and most commonly used method to screen for prostate cancer, rectal exams entail the insertion of a gloved, lubricated finger into the rectum to feel for hard or bumpy areas on the prostate gland. The result of the rectal exam determines whether a man should undergo further testing for the disease.
It is no secret that rectal exams are uncomfortable. And because they are invasive, they deter a number of men from getting tested for prostate cancer.
What Terlecki and colleagues wanted to know was whether or not a finger rectal exam is still needed given the existence of more accurate testing methods for prostate cancer, like a blood test that looks for a prostate-specific antigen (PSA), which will be in high levels in those with the disease.
To find out, they assessed results from a national screening trial where 38,340 men underwent rectal exams and PSA tests annually for three years and were part of a follow-up program for up to 13 years. The researchers also reviewed medical literature on the topic.
Of particular interest to them were 5,064 men who got normal results on PSA tests but "abnormal" ones on rectal exams. And out of these subjects, Just 2 percent had what is called clinically relevant prostate cancer, which would require monitoring or treatment.
According to the researchers, rectal exams do help in identifying a certain subset of men with prostate cancer but they are also unnecessary for a large number of males.
Before 2012, men over the age of 50 (40, if you're African-American) were advised to get both a rectal exam and a PSA test every year. This was before the U.S. Preventive Services Task Forces recommended regular testing for PSA because the method was shown to cause overtreatment of slow-growing but non-harmful tumors. There was no advice regarding rectal exams, which is why confusion persists today.
Previous studies, however, have shown that PSA tests outperform rectal exams in spotting significant disease, detecting 680 cases where rectal exams only identified 317 cases.
On the other end, Terlecki said that rectal exams may be beneficial to patients who register abnormal PSA levels but are not comfortable with biopsies. If a rectal exam yields abnormal results, then they may be likelier to proceed with the procedure knowing that something is indeed wrong.
Whether rectal exams or PSA tests should be used then depends on a man's situation. Aside from simply weighing the pros and cons of rectal exams versus PSA tests, men should also talk to their doctors about needing to screen for prostate cancer in the first place.
According to the American Cancer Society, prostate cancer can be serious but most of those diagnosed with the disease will not die from it. Still, it's the second leading cause of cancer deaths in men in the United States, with one man in every 39 dying from the disease.
Photo: Denis Mihailov | Flickr
