Evaluating prostate cancer diagnostic methods: The role and relevance of digital rectal examination in modern era

Abstract

This review examines diagnostic methods for prostate cancer, focusing on the role of digital rectal examination (DRE) alongside modern advancements like prostate-specific antigen (PSA) testing, Prostate Health Index (PHI), magnetic resonance imaging (MRI), and prostate-specific membrane antigen positron emission tomography (PSMA-PET), particularly in the context of Korea's aging population and healthcare challenges. Technological advancements have significantly improved prostate cancer diagnosis. PSA testing, while widely used, suffers from low specificity, often resulting in unnecessary biopsies. PHI addresses PSA's limitations, offering enhanced accuracy, particularly in the "gray zone" of PSA levels. MRI has revolutionized diagnostic precision, enabling detailed staging and targeted biopsies, but its cost and limited availability restrict widespread use. Emerging tools like PSMA-PET and AI (artificial intelligence)-driven diagnostics promise further improvements but remain costly and complex, limiting their routine application. Despite these advancements, DRE continues to serve as an accessible and cost-effective tool, particularly in low-resource settings or where advanced diagnostics are unavailable. In Korea, where prostate cancer is often diagnosed at more aggressive stages, and universal health insurance emphasizes cost efficiency, DRE retains value as part of a multimodal approach. Concerns about DRE's reproducibility and discomfort remain, but its utility in specific high-risk populations justifies its inclusion in diagnostic strategies. DRE, despite its limitations, remains a valuable tool in Korea's prostate cancer diagnostic landscape, particularly within a comprehensive, cost-effective, and context-sensitive screening strategy.

Keywords: Diagnosis; Digital rectal examination; Magnetic resonance imaging; Prostate-specific antigen; Prostatic neoplasms.