Screening for Prostate Cancer: Are Digital Rectal Examinations Being Performed?

Abstract

Objective: Prostate cancer is common and prostate cancer screening is controversial; this retrospective observational study was conducted to determine the prevalence of digital rectal examination (DRE) in those in whom a prostate-specific antigen (PSA) test was performed. Methods: A manual review was performed of the electronic medical record for male veterans in the VA Connecticut Healthcare System without a history of known prostate cancer aged between 50 and 74 years who underwent PSA testing. Main Outcomes: Documentation of DRE (or refusal) within 12 months before or after the performance of a PSA test. Results: Less than half (47.6%) of patients underwent DRE. An additional 6.9% were offered DRE and refused. Although the provider gender was not associated with DRE, resident physicians were less likely to perform DRE than nonresidents; P = 0.01. Patients whose PSA was > 4.0 ng/mL were more likely to undergo DRE than those whose PSA was ≤ 4.0 ng/mL; P = 0.002. Those with body mass index (BMI) > 40 kg/m2 were less likely to undergo DRE than those with BMI < 30 kg/m2; P = 0.04. Conclusions: Screening for prostate cancer remains controversial. We found a low rate of DRE among veterans in whom prostate cancer screening was entertained. Although the provider gender does not seem to influence DRE, resident physicians were less likely to perform DRE than other providers. Our finding that BMI > 40 kg/m2 is associated with a lower rate of DRE than those with BMI < 30 kg/m2 is consistent with screening for other cancers and should be explored further.