Medscape: The digital rectal exam (DRE) is still a prognostic tool for prostate cancer

8 August, 2019

In this era of big machines, robots and other AI and Big Data, clinicians throw away age-old clinical skills in diagnosis and treatment at their own peril. It has become too quick to make a dash for MRI, CT, PSA what else before even touching the patient. It is still true that 'if you don't put your finger, you will put your feet (trouble)'.

We share this study report courtesy of Medscape: READ ON


DRE Is Still a Prognostic Tool for Prostate Cancer

First-of-Its-Kind Analysis in Modern Era

Nick Mulcahy July 31, 2019

In the modern era of advanced imaging and genomics testing, the digital rectal exam (DRE) is still an "important" and clinically relevant prognostic test for prostate cancer, conclude the authors of a new observational study.

The role of the DRE, which is a "historic" method of staging the disease, has been "uncertain" in recent years, acknowledge the investigators, led by Jenna Borkenhagen, MD, a radiation oncologist at the Medical College of Wisconsin in Milwaukee.

That's because of the availability of other prognostic tools such as the 4K Score, Decipher, and MRI, they say. Plus, no one has studied the question of DRE's usefulness in a more modern setting.

For a long time, the DRE served, along with a prostate-specific antigen (PSA) value and a Gleason score, as the bedrock for assessing prostate cancer prognosis, which influences treatment decisions.

The new observational, retrospective study shows that clinical stage classification via DRE is significantly prognostic in terms of overall survival among men with high-risk localized disease in a modern cohort (treated from 2004-2010) in a US database.

In short, the old tool still works in a contemporary setting.

"Digital rectal exam remains a valuable prognostic tool for prostate cancer patients," Borkenhagen told Medscape Medical News.

The study was published online in the July edition of the Journal of the National Comprehensive Cancer Network.

"The findings reaffirm that prostate cancer clinicians should be using DRE. I use it on all of my patients," said study senior author William Hall, MD, also from the Medical College of Wisconsin, in an interview with Medscape Medical News.

The findings reaffirm that prostate cancer clinicians should be using DRE. Dr William Hall’’


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HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.

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