A new study, published in the Annals of Family Medicine, suggest that the quality of evidence to support the use of digital rectal exams for prostate cancer screenings in the primary care setting is very low.
"[Digital rectal exams are] frequently incorporated as part of a routine primary care examination in men,” Leen Naji, MD, of the department of family medicine at McMaster University in Hamilton, Canada and colleagues wrote.
“Some evidence suggests, however, that the [digital rectal exam] may not significantly reduce mortality, but instead may result in a high number of false positives leading to unnecessary invasive diagnostic tests that can precipitate pain, erectile dysfunction and urinary incontinence, as well as overdiagnosis and overtreatment of prostate cancer.”
Naji and colleagues conducted a systematic review and meta-analysis to determine the diagnostic accuracy of digital rectal exams exclusively performed in the primary care setting. They identified seven studies that included 9,241 patients.
Naji and colleagues found that there was high heterogeneity across the studies, and digital rectal exams conducted by PCPs generally had poor performance. Also, pooled specificity was 0.59, and pooled sensitivity was 0.51.
In addition, the pooled negative predictive value was 0.64 and pooled positive predictive value was 0.41.
“There is a paucity of data evaluating the effectiveness of [digital rectal exams] in the primary care setting,” Naji and colleagues said.
“Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of [digital rectal exams] to screen for prostate cancer in the primary care setting," they concluded.