Digital Rectal Exam and PSA May Detect Distinct Subtypes of Prostate Cancer Interview with:

Jim C. Hu, MD Ronald Lynch Professor of Urologic Oncology Weill Cornell Medicine New York, NY 10065

Dr. Jim Hu

Jim C. Hu, MD
Ronald Lynch Professor of Urologic Oncology
Weill Cornell Medicine
New York, NY 10065 What is the background for this study?

Response: Initial results from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), a large-scale randomized controlled trial of prostate cancer screening in the United States, radically changed the landscape of prostate cancer screening insofar as it led the United States Preventative Services Task Force (USPSTF) to recommend against routine screening with prostate-specific antigen (PSA). Though many subsequent studies have continued to investigate the role of PSA in screening, there is a paucity of data examining the use of digital rectal examination (DRE) for screening in the PSA era. Indeed, the USPSTF recommendation did not explicitly address DRE, calling for further research to evaluate the role of periodic DRE in prostate cancer screening. Likewise, while recent guidelines from the National Comprehensive Cancer Network (NCCN) recommend use of PSA in all men who elect screening, the role of digital rectal examination is equivocal.

We sought to evaluate the value of  digital rectal examination and PSA for detection of clinically significant prostate cancer and prostate cancer-specific (PCSM) and overall mortality in a secondary analysis of the PLCO. What are the main findings?

Response: We found that both suspicious digital rectal examination and abnormal PSA are significant predictors of clinically significant prostate cancer and prostate cancer-specific mortality. Furthermore, we found that these tests demonstrate only moderate agreement with one another. That is, among men with an abnormal DRE, only 15.4% had a concurrently abnormal PSA, suggesting that these tests may detect distinct subtypes of prostate cancer. What should readers take away from your report?

Response: While the pendulum has swung away from routine prostate cancer screening with PSA and DRE in the wake of the USPSTF recommendations, these tests remain valuable tools in the detection of prostate cancer. However, the optimal indications and protocols for their use have yet to be fully elucidated.

The potential downside for screening tests is that they may lead to a biopsy which may have low risks of infections and the diagnosis of indolent cancers in which the treatment may be worse that the disease characteristics. However, to address the latter, physician and patient understanding of low risk prostate cancer has improved, leading to much greater acceptance of active surveillance as a reasonable course. Therefore research and education are overcoming the potential for over-treatment of indolent disease. What recommendations do you have for future research as a result of this study?

Response: Additional research is needed to optimize screening protocols and further evaluate the synergistic relationship between  digital rectal examination and PSA. Future studies must also attempt to integrate these tests with newer technologies in order to devise targeted protocols that can better serve individual patients. Advances in imaging and biomarkers must be used in concert with these traditional tests to improve the patient selection of men who are at high risk for clinically significant prostate cancer. Is there anything else you would like to add?

Response: Prostate cancer screening remains a complex and nuanced issue. Our findings support a continued role for both digital rectal examination and PSA in the context of shared decision-making and individualized screening regimens. Thank you for your contribution to the community.


Prognostic Significance of Digital Rectal Examination and Prostate Specific Antigen in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Arm
Halpern, Joshua A. et al.
The Journal of Urology , Volume 0 , Issue 0 ,

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on

[wysija_form id=”5″]