Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun 2;19(1):79.
doi: 10.1186/s12875-018-0765-y.

The diagnostic test accuracy of rectal examination for prostate cancer diagnosis in symptomatic patients: a systematic review

Daniel Jones  1 , Charlotte Friend  2 , Andreas Dreher  3 , Victoria Allgar  4 , Una Macleod  2
Affiliations

The diagnostic test accuracy of rectal examination for prostate cancer diagnosis in symptomatic patients: a systematic review

Daniel Jones et al. BMC Fam Pract. .

Abstract

Background: Prostate cancer is the most common cancer in men in the UK. NICE guidelines on recognition and referral of suspected cancer, recommend performing digital rectal examination (DRE) on patients with urinary symptoms and urgently referring if the prostate feels malignant. However, this is based on the results of one case control study, so it is not known if DRE performed in primary care is an accurate method of detecting prostate cancer.

Methods: The aim of this review is to ascertain the sensitivity, specificity, positive and negative predictive value of DRE for the detection of prostate cancer in symptomatic patients in primary care. CENTRAL, MEDLINE, EMBASE and CINAHL databases were searched in august 2015 for studies in which a DRE was performed in primary care on symptomatic patients and compared against a reference diagnostic procedure.

Results: Four studies were included with a total of 3225 patients. The sensitivity and specificity for DRE as a predictor of prostate cancer in symptomatic patients was 28.6 and 90.7%, respectively. The positive and negative predictive values were 42.3 and 84.2%, respectively.

Conclusion: This review found that DRE performed in general practice is accurate, and supports the UK NICE guidelines that patients with a malignant prostate on examination are referred urgently for suspected prostate cancer. Abnormal DRE carried a 42.3% chance of malignancy, above the 3% risk threshold which NICE guidance suggests warrants an urgent referral. However this review questions the benefit of performing a DRE in primary care in the first instance, suggesting that a patient's risk of prostate cancer based on symptoms alone would warrant urgent referral even if the DRE feels normal.

Keywords: Digital rectal examination; Early diagnosis; General practice; Primary care; Prostate Cancer.

PubMed Disclaimer

Conflict of interest statement

Ethical approval and consent to participate

Not required for this systematic review.

Competing interests

The authors declared that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA Diagram
Fig. 2
Fig. 2
Pooled sensitivity and specificity for DRE as a predictor of prostate cancer in symptomatic patients
See this image and copyright information in PMC

References

    1. Cancer Research UK. Cancer Statistics for the UK 2015 [cited 2015 27th July].
    1. Preventative Services US, Force T. Draft recommendation statement: prostate Cancer. Screening. 2017;
    1. Public Health England. Prostate Cancer Risk Management Programme 2015 [cited 2015 27th July].
    1. Hamilton W, Sharp DJ, Peters TJ, Round AP. Clinical features of prostate cancer before diagnosis: a population-based, case-control study. The British journal of general practice : the journal of the Royal College of General Practitioners. 2006;56(531):756–762. - PMC - PubMed
    1. Frankel S, Smith GD, Donovan J, Neal D. Screening for prostate cancer. Lancet. 2003;361(9363):1122–1128. doi: 10.1016/S0140-6736(03)12890-5. - DOI - PubMed

Publication types