Grupo de Estudos em Semiologia e Propedêutica

Digital rectal exam may be ineffective for prostate cancer screening, meta-analysis indicates

Digital rectal examination (DRE) does not appear to be effective in screening for prostate cancer, according to a recent study.

Researchers performed a systematic review and meta-analysis of studies published through June 2016 to examine the diagnostic utility of DRE in primary care. Included studies needed to specify that a primary care clinician performed the DRE. In addition, all patients had to have received a DRE regardless of symptoms, prostate-specific antigen level, or other prognostic factors, and biopsy had to be used to determine diagnosis. Data were extracted from eligible studies, and pooled estimates for sensitivity, specificity, positive predictive value, and negative predictive value were calculated. The study results were published in the March/April Annals of Family Medicine.

Seven studies involving 9,241 patients who had both DRE and biopsy were included in the analysis. For DRE performed by primary care clinicians, the pooled sensitivity was 0.51 (95% CI, 0.36 to 0.67) and the pooled specificity was 0.59 (95% CI, 0.41 to 0.76). The pooled positive predictive value was 0.41 (95% CI, 0.31 to 0.52), while the pooled negative predictive value was 0.64 (95% CI, 0.58 to 0.70). The evidence was considered low-quality according to GRADE (Grades of Recommendation Assessment, Development, and Evaluation) guidelines.

The authors noted that many studies in the literature search did not explicitly report the setting where DRE was performed or who performed it. In addition, the included studies varied in setting and reported diagnostic accuracy, and only patients with a positive result on DRE or an elevated prostate-specific antigen level had a biopsy, they wrote. They concluded that high-quality data on DRE effectiveness in primary care are lacking and recommended against routine screening for prostate cancer with DRE in primary care, “so as to minimize unnecessary diagnostic testing, overdiagnosis, and overtreatment.”