Han: The exam is more valuable than ever.Men hate it, and their doctors don’t particularly like it, either, but they go through with it because it has saved countless lives, particularly when done yearly in combination with a PSA blood test. Now, it turns out that the digital rectal examination is more valuable than we realized. A new study has found that it can accurately predict whether a man’s cancer will come back after surgery.
“We knew that men with a palpable prostate cancer” — a tumor that can be felt through the wall of the rectum during the exam — “have a higher likelihood of recurrence following surgery,” says Misop Han, M.D. But a recent study, led by Han, with Jeffrey Mullins, M.D., and Patrick C. Walsh, M.D., took this a step further. The team investigated whether the absence or extent of a palpable nodule before surgery (this is also known as clinical stage) could accurately predict long-term, cancer-free survival after surgery.
The study included more than 4,100 men who had both the digital rectal examination and radical prostatectomy done by Walsh between 1983 and 2009.
The study included more
than 4,100 men who had both
digital rectal examination and
radical prostatectomy by Walsh
between 1983 and 2009.
“We found that most people do not die from prostate cancer after surgery,” says Han. Specifically, fewer than 4 percent of these men died from prostate cancer. They also discovered that men who had nonpalpable prostate cancer — cancer that is too small to be felt during the exam — before surgery (clinical stage T1c) lived significantly longer than those with palpable prostate cancer (clinical stage T2).
“We found that, for men with palpable disease, the extent of the palpable cancer was directly associated with survival. Thus, having an accurate digital rectal examination is crucial in allowing doctors to give appropriate advice and guidance to their patients with prostate cancer.” The good news, Han adds, is that because more men are being screened for prostate cancer, more men are diagnosed with nonpalpable cancer.