This will please most men, as men hate having a prostate check done per rectum (PR) as doctors have done for years. Now we know they were a waste of time in a normal man. If a man has symptoms of prostate trouble, then that is different.

No place for digital rectal exams’ in general practice

27 January, 2016 Clare Pain 1 comments Read Later

GPs are being actively discouraged from conducting digital rectal examinations (DREs) of asymptomatic men in the new NHMRC-approved prostate cancer testing guidelines, but some are not happy.

The new advice has moved some GPs to recall their training adage: “If you don’t put your finger in it, you’ll put your foot in it.”

One doctor noted he had been encouraged to do DREs as a student so as to get a feel for what was normal and what was not.

Another commented: “What, no more prostate exams? I would have thought that was still important as part of the GP assessment in conjunction with PSA. Some of my patients will be happy.”

Among the “take-home messages” promoted by the guideline developers, the Prostate Cancer Foundation of Australia and Cancer Council Australia, is the statement that “digital rectal examination is not recommended for asymptomatic men as a routine addition to PSA testing in the primary care setting, but remains an important part of specialist assessment”.

One GP puzzled over the rationale for specialists being encouraged to do DREs but not GPs.

“The biggest determining factor in detecting a malignancy is how often you do the examination (that, and the length of your finger),” he says.

But Professor Chris Del Mar, who represented the RACGP on the guidelines committee, is quite clear there is no place for DREs in asymptomatic men.

“For screening, the DRE doesn’t provide any additional benefit. It’s a pretty hopeless test,” he says. “The only reason for doing it would be medico-legal, and that’s not worth doing.

“It’s not a necessary test and it doesn’t provide any benefit at the population level.”

Professor Del Mar, from Bond University, says many doctors want to cling to non-evidence-based activities.

“A similar debate happened, for example, in cervical screening for women, doing a bimanual examination where you feel the uterus and feel the ovaries at the same time as doing a Pap smear.

“That was standard practice a few decades ago, but it’s been shown… that doesn’t provide any additional benefit either.”

Professor Del Mar says for both the bimanual examination and DRE, patients undergo something “which is not perfectly agreeable and for no benefit”. “Don’t do it then!”

But he says for men with symptoms, a rectal examination conducted by the GP could be appropriate, and that specialists contemplating surgery on the patient may need to use a DRE to assess prostate size.