Digital rectal exam (DRE)
A Digital Rectal Exam (DRE) is a medical procedure in which a healthcare provider uses a gloved, lubricated finger to examine the rectum for abnormalities, including checking the prostate gland in men. This exam serves as a screening tool for various cancers, particularly prostate, rectal, and colon cancers, allowing physicians to detect irregularities such as lumps or unusual thickness in the rectal wall. Although previously recommended annually for men over fifty, recent guidelines emphasize informed decision-making regarding prostate screenings, particularly for high-risk groups like Black American men or those with a family history of prostate cancer.
The DRE is a brief procedure that typically causes minimal discomfort and does not require special preparation; patients have the option to request a chaperone during the exam. Following the DRE, if any abnormalities are found, further tests such as colonoscopies or PSA blood tests may be suggested for a more comprehensive evaluation. While the DRE itself poses no direct risks, the potential for false-positive or false-negative results in prostate cancer screening has led to changes in screening recommendations to balance the benefits and uncertainties involved. Overall, the DRE remains an important component in the early detection of certain cancers.
On this Page
Subject Terms
Digital rectal exam (DRE)
ALSO KNOWN AS: Rectal exam, prostate exam
DEFINITION: In this procedure, a gloved, lubricated finger is inserted into the rectum to check for abnormalities in the rectal wall. For men, the size and shape of the prostate gland can also be checked for any abnormalities.
Cancers diagnosed:Prostate cancer, rectal cancer, colon cancer
Why performed: A digital rectal exam (DRE) is a simple procedure used to screen for rectal, prostate, and colon cancers. This procedure allows the physician to check for any abnormal thickness or lumps in the rectal wall.
For men, the physician can also check the prostate gland for any unusual characteristics, such as an increase in size or nodules and lumps, since it is next to the rectum. The benefit of the DRE as a screening tool for prostate cancer is that it can reach a part of the prostate gland where most cancers generally begin. The American Cancer Society (ACS) has previously recommended that men over fifty get a DRE annually. Starting in 2010, however, that recommendation changed. The ACS began recommending that men over fifty are first informed of the uncertainties, possible risks, and potential benefits associated with annual prostate screenings. If they and their physicians agree to yearly screenings, the recommended procedure is a blood test of prostate-specific antigen (PSA) levels, with DRE optional. High-risk men, namely Black American men and those with a family history of prostate cancer, should begin the process of informed decision-making starting at age forty or forty-five, depending on their level of risk. Men who present with a PSA level under 2.5 nanograms (ng) per milliliter (mL) can retest every two years, while those with a PSA level over 2.5 ng/mL should be tested annually. Some physicians recommend a cutoff level of four ng/mL. Individuals with a PSA over ten have a 50 percent chance of having prostate cancer.
Around 15 percent of men with a PSA level lower than four ng/mL are diagnosed with prostate cancer after a biopsy, making DRE a vital screening tool. For women, this procedure may be performed as part of an annual exam but is not explicitly recommended for early cancer detection.
Patient preparation: No special preparation is needed for this procedure. However, if the patient will be under anesthesia for another procedure, health care providers are required to give patients the opportunity to provide written informed consent before performing sensitive exams, including rectal exams. Patients may request a chaperone be present in the room during the procedure and may also decline the presence of additional staff.
Steps of the procedure: A gloved, lubricated finger is inserted into the rectum. There may be slight discomfort during the exam, but this is a quick procedure that generally takes only a few minutes. A stool sample called a fecal occult blood test may also be taken to check for the presence of blood, which may indicate colon cancer.
After the procedure: There are no special instructions, and patients can return to normal activities after the procedure is completed.
Risks: No risks are associated with the exam itself. However, the non-negligible rates of false results in prostate cancer screening may lead to either unwarranted anxiety and unnecessary biopsies (false-positive) or the cancer remaining untreated and the patient dismissing future health concerns (false-negative), which is why the ACS modified its recommendation for men's annual prostate screenings.
Results: If abnormalities are detected during the procedure, then the physician will recommend additional screening tests, such as a colonoscopy or sigmoidoscopy, which are both used to screen for colon cancer. If a problem is suspected with the prostate gland, then a PSA blood test, an ultrasound, or possibly a biopsy of the prostate gland may be suggested to screen for prostate cancer. Some medical providers prefer a multi-parametric magnetic resonance imaging (mpMRI) scan over a DRE for initial investigation and determining whether a biopsy is necessary.
Bibliography
"American Cancer Society Recommendations for Prostate Cancer Early Detection." American Cancer Society, 22 Nov. 2023, www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/acs-recommendations.html. Accessed 22 May 2024.
Ashraf, Imran, et al. "Digital Rectal Examination versus Spontaneous Passage of Stool for Fecal Occult Blood Testing." National Library of Medicine, 2012, ww.ncbi.nlm.nih.gov/books/NBK100231. Accessed 22 May 2024.
Cheng, Mira. "Written Patient Consent Required for Sensitive Exams, HHS Guidance Says." CNN, 1 Apr. 2024, www.cnn.com/2024/04/01/health/hospitals-written-patient-consent-pelvic-exams-hhs/index.html. Accessed 22 May 2024.
Ford, Marvella E., et al. "Effects of False-Positive Prostate Cancer Screening Results on Subsequent Prostate Cancer Screening Behavior." Cancer Epidemiology, Biomarkers & Prevention, vol. 14, no.1, 2005, pp. 190–94. doi.org/10.1158/1055-9965.190.14.1.
Ramanathan, Anshul, and Benjamin Smith. "The Importance of Digital Rectal Examination in Identifying Early-Onset Rectal Malignancies." Cureus, vol. 16, no. 5, 2024, doi.org/10.7759/cureus.59458.
"Screening Tests for Prostate Cancer." American Cancer Society, 22 Nov. 2023, www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/tests.html. Accessed 22 May 2024.