Underutilization of Digital Rectal Examination When Screening for Prostate Cancer | Cancer Screening, Prevention, Control | JAMA Internal Medicine | JAMA Network
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Original Investigation
February 9, 2004

Underutilization of Digital Rectal Examination When Screening for Prostate Cancer

Author Affiliations

From the Department of Internal Medicine, Albany Medical College, Albany, NY (Drs Murthy and Pasquale); and Stratton VA Medical Center (Drs Murthy and Pasquale and Mr Byron). The authors have no relevant financial interest in this article.

Arch Intern Med. 2004;164(3):313-316. doi:10.1001/archinte.164.3.313

Background  Screening for prostate cancer is controversial. American Cancer Society and American Urology Association recommend screening with both digital rectal examination (DRE) and prostate-specific antigen (PSA) testing. Often, PSA testing is not combined with DRE when screening for prostate cancer.

Methods  We collected a list of veteran outpatients who had PSA testing performed between June 1, 1998, and September 30, 1998, from our computerized database. We reviewed their records for documentation of age, race, urinary symptoms, family history of prostate cancer, DRE, and professional training and sex of the health care provider.

Results  Of the 588 records reviewed, DRE was not performed in 311 patients (52.9%). Digital rectal examination was not performed in 276 (53.2%) of 519 patients who had a PSA level less than 4.0 ng/mL; in 202 (58.7%) of 344 patients by male providers and in 109 (44.9%) of 243 patients by female providers (P<.001); and in 231 (61.1%) of 378 patients by doctors of medicine (MDs), 24 (40%) of 60 patients by physician assistants (PAs), and in 56 (37.3%) of 150 patients by nurse practitioners (NPs) (MDs vs PAs, P<.001; MDs vs NPs, P<.001; and NPs vs PAs, P = .42).

Conclusions  Digital rectal examination is underutilized when screening for prostate cancer. This leads to nondetection of some prostate cancers. Although the DRE rate was poor among all health care providers, female providers and physician extenders outperformed male providers and physicians, respectively.