Measurement of serum prostate-specific antigen (PSA) and digital rectal examination (DRE) are commonly used for prostate cancer screening. Clinicians have been advised to avoid measuring serum PSA after DRE because of the possibility of spurious elevation. However, studies in healthy volunteers have found no change. We sought to determine whether DRE performed by internists affects PSA levels in a primary care clinic population.
Men older than 49 years enrolled in a Veterans Affairs internal medicine clinic were eligible for the study. For all patients, prostate size and nodularity were assessed by DRE. Blood for determination of PSA levels was drawn immediately before DRE and 30 minutes after DRE. All patients completed a questionnaire regarding voiding.
Two hundred two men aged 50 to 85 years (mean, 67 years) were enrolled and had complete data. The mean PSA level increased by 0.26 μg/L after DRE (P<.001). Six patients (2.9%; 95% confidence interval, 0.6% to 5.3%) had an increase in PSA level from less than 4 μg/L to more than 4 μg/L after DRE. There was a statistically significant but weak correlation between voiding score and PSA level (coefficient,.17; P=.02). Patients with an enlarged prostate gland had higher PSA levels than did patients with normal prostates or borderline results of examination. Nodularity did not predict an increased PSA level.
We conclude, in an elderly veteran population, that DRE causes a statistically significant but clinically insignificant increase in serum PSA level. Additionally, we found that symptoms and physical examination results cannot be used to select a population for whom PSA screening would likely be useful.(Arch Intern Med. 1995;155:389-392)
Andruss CM, Dinella TJ, Macpherson DS, Pietropaoli AP, Tsao L, Wachman J, Whittle J, Cameron ML, Hines JM, McNeil M, Conigliaro J, Good CB, Labkoff SE, Andruss CM, Cohen MG, Deswal A, Dinella T, Gulinson MD, Hankin LM, Heinle MS, Higham CJ, Hoffman EL, Hunn RH, Hunter TM, Kam LW, Leon RJ, Lilie S, Lipinski JL, Marr LA, McCullum KJ, Michelson GC, Nace DA, O'Rourke DJ, Osborn JL, Pendergast WJ, Provensano MA, Ramsey LC, Reardon LC, Sandberg MI, Szawaluk JJ, van Cleeff S, Young MA, Yee EL, Zeldin RK, Bushman KE, Richards DS, Jill , Balderston V, Caldwell KE, Collins ME, Dianesi EG, Dale CG, Dippl JM, Finikiotis MW, Finkel RG, Friedland DM, Gorby RS, Guilinger RA, Hally RJ, Hammerman SI, Harris JV, Keyes KJ, Leuzzi RA, Lubick CJ, McGuiness MA, Needleman DC, Pritchard RJ, Rodman MT, Rohn SG, Santora DM, Schloss EJ, Selvaggi TA, Shuster TD, Stein AR, Sweet LJ, Tee ST, Thomas A, Hogan RC, Kosar EM, Murtaugh TI, Hartle J, Lofgren RP, Macpherson DS. Effect of Digital Rectal Examination on Serum Prostate-Specific Antigen in a Primary Care Setting. Arch Intern Med. 1995;155(4):389-392. doi:10.1001/archinte.1995.00430040063007