No benefit of digital rectal/ PR exam in primary care : Study

The digital rectal examination (DRE) is commonly performed by Clinicians to screen for BHP and prostate cancer. As of now, there is limited data to support its use in primary care.Dr.Leen Naji and associates conducted a Systematic Review and Meta-Analysis to evaluate the diagnostic accuracy of DRE in screening for prostate cancer in primary care settings.The researchers found that digital rectal examination (DRE) for prostate cancer screening in primary care should be discouraged given "the lack of evidence supporting its use."The new study finds limited data to support its effectiveness and also it has its risks for overdiagnosis and overtreatment. The study has been published in in the Annals of Family Medicine.

The researchers searched MEDLINE, Embase, DARE (Database of Abstracts of Reviews of Effects), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from their inception to June 2016. Six reviewers, in pairs, independently screened citations for eligibility and extracted data.

The analysis encompassed seven studies measuring the effectiveness of DRE in screening for prostate cancer in primary care settings. The studies included some 9000 patients who underwent a DRE by primary care clinicians and, based on the results, a subsequent biopsy. The studies showed a high risk for bias, and the overall quality of evidence was rated as "very low."

From the studies' pooled results, DRE's sensitivity was estimated to be 0.51, with a specificity of 0.59 and a positive predictive value of 0.41.

Writing in the Annals of Family Medicine, the researchers say they "Given the considerable lack of evidence supporting its efficacy we do not recommend routine screening ... using DRE in primary care," given the risks for overdiagnosis and overtreatment.

For more details click on the link : doi: 10.1370/afm.2205