Our Greatest Wealth Is Health

Andrew Siegel MD   4/13/19

A DRE is not a fancy and sophisticated high-tech “digital” as opposed to “analog” test.  “Digital” does not refer to a series of data represented by zeroes and ones, but rather to the digit that is used to perform the exam, typically the index finger of the examining physician.  “Rectal” is self-explanatory, referring to the anatomical structure entered to access the prostate gland.  

The slender digit of yours truly

Caveat Emptor:  Always scrutinize the index finger of your urologist before allowing him or her to lay a finger on you…if they are sausage-like or have long nails… 

Please note well the following fact that is misunderstood by many patients:  Although the anus and rectum are the portals to the prostate, urologists are NOT colon and rectal doctors, nor do we do colonoscopies.  That is under the domain of the gastroenterologist or colo-rectal surgeon. Same portal, different organs!  Just because you have had a colonoscopy does not imply that you have had a proper DRE of the prostate. 

A DRE is a vital part of the male physical exam in which a gloved, lubricated finger is placed gently in the rectum in order to feel the outer, accessible surface of the prostate and gain valuable information about its health.  There are many positions in which to perform the test, but I prefer the standing, leaning forward with elbows on exam table position. Another position is the lying on your side, knees bent upwards towards chest position. Both are perfectly acceptable.

True story:  When I was on  the receiving end of my first DRE, I passed out and needed to be revived with an ammonia inhalant!  It has never happened again, but I do literally “see stars” during my annual exams, which are truly humbling.  My conclusion is that it is always better to give than receive. 

After age 40, an annual DRE is highly recommended. Although it is not a particularly pleasant examination, it is brief and not painful. Urologists do not relish doing this exam any more than patients desire receiving it, but it provides essential information that cannot be derived by any other means. If the prostate has an abnormal consistency, a hardness, lump, bump, or simply feels uneven and asymmetrical, it may be a sign of prostate cancer.  Prostate cancer most commonly originates in the peripheral zone, that which is accessed via DRE.

Illustration above from PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families, written by yours truly

When teaching medical students, we often use hand anatomy to explain what the prostate feels like under different circumstances.  Turn your hand so that the palm is up and make a fist. The normal prostate feels like the spongy, muscular, fleshy tissue at the base of the thumb, whereas cancer feels hard, like the knuckle of the thumb.

DRE in conjunction with the PSA (prostate specific antigen) blood test is the best means of screening for prostate cancer. Detection rates for prostate cancer are highest when using both tests, followed by PSA alone, followed by DRE alone.

The pathological features of prostate cancers detected on an abnormal DRE are, in general, less favorable than those of cancers detected by a PSA elevation. In other words, if the cancer can be felt, we tend to worry about it more than if it cannot be felt, as it is often at a more advanced stage.

Fact: The PSA blood test is NOT a substitute for the DRE. Both tests provide valuable and complementary information about your prostate health.

Bottom Line:  This simple test can be life-saving, so please “man up” and endure the momentary unpleasantness.  Remember that prostate cancer is the number 1 malignancy in men (aside from skin cancer) and cancers can be discovered on the basis of an abnormal DRE, even in the face of normal PSA. 

Tags: abnormal digital rectal exam, Andrew Siegel MD, digital rectal exam, prostate, prostate cancer, Prostate Cancer 20/20, prostate cancer screening, PSA

This entry was posted on April 13, 2019 at 6:24 AM and is filed under health and wellness. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.