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Digital rectal examination, a common method of detecting prostate cancer, is not precise enough to be reliable, scientists announce at a urology conference. These call for a change of procedure.
Widely used by healthcare professionals to detect early prostate cancer, the digital rectal examination (using a finger) is particularly used to look for a physical sign that is eloquent to the touch, such as an unusual swelling. or bumps in the rectum. But new research by German scientists from a trial called PROBASE suggests that the technique can miss many cancers in their early stages, when the notion of precocity is paramount in the management of this cancer. Their results are presented today at the Annual Congress of the European Association of Urology in Milan.
Blood test picks up 4 times more cases
The trial in question was conducted by 4 German university sites, involving 46,495 men aged 45 who were enrolled between 2014 and 2019. The men have since been followed to assess their health in the years following screening.
Half of the trial participants were offered a prostate-specific antigen (PSA) blood test immediately at age 45, while the other half were initially offered a digital rectal examination with delayed PSA screening at 50 years old.
Ultimately, 6,537 men in the delayed screening group underwent digital rectal examinations and only 57 of these men were referred for follow-up biopsy due to suspicious results. Only three were diagnosed with cancer. A relatively low rate, it seems, compared to the detection rate using other methods.
“The fingertip gave a negative result in 99% of cases and even those who were deemed suspicious had a low detection rate.“, explains Dr. Krilaviciute lead author of the study. “The results we saw from the PROBASE trial show that the PSA test at age 45 detected four times as many prostate cancers.”
Changes too slight to spot on your finger
Why would this review be unreliable? The researchers posit one reason in particular: in younger men especially, changes in prostate tissue may be too slight to detect. In addition, some cancers arise in a part of the prostate that is difficult to reach with a finger.
“Early-stage cancer may not have the size and stiffness necessary to be palpable,” confirms Professor Peter Albers, also an author. “A separate analysis that used MRI scans before biopsies to locate prostate cancers showed that around 80% of them are in an area that should be easy to reach with a finger and that the cancers don’t were still not detectable by touch”.
PSA + MRI for more precise screening… and less inconvenient
Thus, researchers are now advocating for the widespread use of PSA tests and MRIs in screening programs instead of digital rectal examination. A change in procedure which could also regulate another aspect of the screening: many men who evade it, put off by the rectal examination. “In Germany, for example, the participation rate is less than 20% in the screening program for men aged 45 to 50. If we were to offer PSA tests instead, more of them might be willing to come” confirm the researchers.
The important thing is to promote access to early screening: in France around 50,000 new cases of prostate cancer are detected each year. The earlier they are perceived, the more favorable the vital prognosis.
In France, no systematic screening for prostate cancer
According to the High Authority for Health, the benefit of screening for prostate cancer has not been clearly demonstrated: in other words, we do not know if it makes it possible to avoid deaths linked to prostate cancer, for lack of concordant conclusions. between the two international studies conducted on the subject.
To date in France (but also abroad), the health authorities do not recommend systematic screening for prostate cancer by measuring the PSA (prostate specific antigen) in men without symptoms.
Nevertheless, this screening can be discussed on a case-by-case basis with your doctor, who will have to discuss with you the advantages and disadvantages of the screening examinations and their consequences.