End of the line for DREs?

According to the Sunday Times this morning, one of the associations of surgeons, together with the charity Prostate Cancer UK, are petitioning the authorities to update the guidelines for prostate cancer detection to exclude digital rectal examinations. Apparently, in the UK 30% of men avoid going to their GPs with symptoms in order to avoid having to submit to having a finger stuck up their bottoms. This is surely crass stupidity on so many levels.

If the DRE no longer works, then that should be the only critieria for its discontinuation. It looks to me that this is the case. What do others think?

@Dr_Higgs I visited a urologist lately. He had me take a PSA test and conducted a transabdominal ultrasound examination. He then said that as nothing threatening could be seen he would not do a digital rectal exam. Perhaps the availability of modern imagery techniques reduces the need for rectal exams?

(On a similar line, I had DREs when I was a kid to check for appendicitis. Nowadays, this would be done using modern imagery.)

Hey guys! The DRE saved me! Five years ago, my PSA had not reached a level that was considered alarming for possible prostate cancer. But my urologist said he detected abnormalities in my prostate with a DRE. I soon had a biopsy done and sure enough, I had early stage prostate cancer. Radiation was done and five years later, all is well. I still have annual PSAs and DREs done. My latest PSA was .07. And the DRE — Well….It felt wonderful!

@Dr_Higgs is right, the reason for discontinuing DREs g should be based on their effectiveness, which some say is questionable, not because some men avoid medical care because they're squeamish about it - that’s stupid. They can always refuse the DRE test and opt for PSA or imagery. DREs are only an indicator for prostate cancer, they only examine a portion of the prostate (most of the gland is not accessible digitally). However, they can be an indicator for an enlarged prostate which effects urinary problems. For me, if a doc wanted to do a DRE, fine. If they felt something abnormal I’d ask for imagery to confirm it before more invasive testing.

Women routinely have more intimate and invasive tests. The 30% wimps who avoid medical care because of fear of a DRE need to man up.

Imho it is the case, when better be safe than sorry. Modern scanning machines are good, yes, but DRE still will give more precise examination. And with consequences, prostate cancer brings... Even I, who visit medical facilities only for annuals, thinks this initiative is damn stupid.

Would one rather under go a finger up the butt to detect an issue or forget the finger and deal with prostate cancer.? Not every guy uses common sense and lack of common sense can lead to major medical issues

Not performing a digital rectal exam is absurd. A digital rectal exam is the only way to reach a definitive diagnosis. About 20% of prostate tumors grow without increasing PSA. In addition, other diseases can be detected through digital rectal exams, such as intestinal tumors. It also helps establish criteria for treating urinary symptoms.

You should perform a digital rectal exam even if your PSA (prostate-specific antigen) screening test is low. The PSA only assesses whether something is wrong with the prostate. To determine whether it is a tumor, inflammation, or just a benign enlargement, you need to perform a digital rectal exam.

I went to a new Urologist a couple weeks ago. I had not seen one for over 3 years and the VERY good one I saw then has left the area. I was scheduled for a 30 minute new patient visit. All she did was go over my medication list and glance at the list of issues that I had made. She doubled my BPH medication and adjusted my ED medication. Then she said that she would see me in 3 months. I firmly believe that every new patient with ANY doctor should get a complete physical so the practitioner has a baseline knowledge of the patient's physical appearance and tactile sense of the area that the patient is there for. I know that some medical personnel here and elsewhere say it is a waste of time because 90% of the time, nothing out of the ordinary is found. But if I am one of the 10% who has an issue discovered from an exam, I would be extremely grateful that the provider insisted on doing a thorough exam. Yes, I could have asked about the exam, and I may next time, but I just thought that with me being old and her being young, she would have thought that I was just being a creep.

With PSA test and various scans that actually show internal organs, DRE should be rightly so abandoned. For many it was purely humiliating procedure with high lever or errors.

I understand that many on zity will be very disappointed. My advise, find a play partner or just use own finger. Medical professionals are not there to feed your fetish.

Sadly, medicine, as any other profession that creates power gradient, attracts people with some personality disorders, and I think they just loved to come up with unpleasant and often humiliating procedures. Luckily, nowadays with progress in technology, and more importantly wider and more scrutinising reviews, this is dying trend.

Just remember that not long ago lobotomy widely accepted and routine procedure that majority of doctors believed in.

I recently visited a new doctor, aged 70 or so, who considers himself "Old School". While he did have me strip down to my underwear for my new patient physical, he did not perform a DRE, explaining that most men freak out about that and would do it on a follow-up visit only in my PSA number was elevated. Doesn't give me hope that future visits will be more thorough. A hernia check or genital inspection was also not done.

It is very important check your prostate with a finger. You may feel a tumor that does not show up on bp the labwork

I think men should also check their semen when they masturbate to see if it’s changed in coloration from previous sessions. If a dark brown coloration is noted a DRE would definitely be in order in my non-medical opinion.

About 10 - 15 years ago (I'm 85) my doctor at the time felt a nodule on my prostate, so although my psa was low and unchanged it was off to the urologist for a biopsy. He must have taken 24 samples, and the result thankfully was negative. But my semen was dark for a month afterward from the induced prostatitis. I haven't had a dre since, aged out of them, I guess.

If it wasn't for the DRE, I would have been dead 21 years ago. The PSA only confirms the DRE. You aren't gay because you have a finger up your ass in a medical exam. Your wise!!!

I am now in my mid 70's and have been going for a yearly physical for most of my adult life after my late 30'/early 40's. I have had about 4 primary care docs since I reached the age of 40. Not even one single doctor has ever brought up wanting to check my prostate during a routine physical. In later years I did have PSA labs done every year and my PSA is very low, but PSA testing was not available when I was younger. I can only assume that many doctors are not all that eager to perform a DRE, or do not think it is important. I always felt that I received good care from those doctors, and they were all in their 40's-50's during the time I was their patient. The ONLY time I had a DRE was when I was seen for severe lower abdominal pain when I was in my 20's....and I was diagnosed with prostatitis.

I haven’t had a DRE in nearly 10 years, during which time I have been treated at a university-affiliated, teaching hospital. My PSA is monitored twice yearly.

I am still given a DRE yearly during my annual exam. I am also given a PSA test every three years. I don't have a problem with getting a DRE done, it makes me feel confident and reassured that they are not missing anything.

DRE is pretty useless for detecting prostate cancer. There is a lot of data to confirm it. As much as I like anal play, I am not looking for this to be done during medical examination, especially when it is pointless. As well, being excited about real medical procedures is plain wrong. Nurse or doctor are not your play partners and they never gave any consent for participating in your fetish.

For those interested in real information:

https://www.sciencedirect.com/science/article/pii/S2588931123002924

DRE exhibits a notably low diagnostic value

https://prostatecanceruk.org/about-us/news-and-views/2023/03/dre-aren-t-good-at-catching-prostate-cancer-early

DRE alone is not an effective test for prostate cancer. A doctor or nurse can’t feel the whole prostate

https://pmc.ncbi.nlm.nih.gov/articles/PMC10904122/

The performance of stand-alone DRE to screen for prostate cancer is poor

I could carry on with this list for long.

I have posted on another similar thread that I believe DRE should continue to be done. It costs nothing, does add information, but as pointed out seems to be considered too invasive by some. PSA is inexpensive and sensitive, but leads to a fair number of false positives. TRUS is more expensive and invasive, and can have both false posives and negatives. I will continue to insist on yearly DRE's, possibly adding PSA's, and TRUS/biopsies as needed. We should be using all the technology we have in a cost-effective manner.

https://en.zity.biz/index.php?mx=forum;ox=display;msg=1429712

I've been having DRE's done for years either by my GP or urologist. I don't want any problems at any time. So far, so good. The one thing I don't like is once you're past the age of 74 they don't think occult blood tests are necessary. However, my GP doesn't agree, thankfully.

People can say what they want and entitled to an opinion. But there is no finger that can detect cancer. It’s usually from image analysis and if serious enough a biopsy thats why a DRE is becoming a thing of the past. It’s not necessary and prone to misdiagnosis. If the symptoms prevail then image analysis is how it’s detected.

You’re on rocky ground if you think a finger up the rear is going to keep you in the clear. The scores are in. It’s 99% ineffective.

@Dr_Higgs

That is pure Medical stagnation. Nothing else. However, stagnation is more predictable with socialized medicine, per my experiences. And yours? 🤔

I have to answer this question. The only reason I am 23 years older, is a doctors finger up my ass who diagnosed prostate cancer when my regular physician said all was wonderful, but did not do a DRE. He referred to my PSA number. Biopsies, subsequently confirmed the doctors diagnosis, and here I am.

I haven’t had a real physical exam with a DRE, genital exam, abdominal exam, palpation of glands/pulses, etc. since 2021. All it is now is a quick, how do you feel? Followed by lab orders. If you report anything or any results come back off, you get sent to a specialist for more of the same. I guess lab tests are getting so good that they replace everything.

I have seen differing opinions back and forth over the years. PSA is a decent screening tool but does sometimes give false results. Imaging tests are good but can be invasive worse than the DRE. I was taught to go from the simplest to most complex, and I, personally, feel that a decent procedure is a PSA and DRE for the actual physical exam, and then only if something is suspected, do imaging tests.

My primary care physician has told me that every patient with a prostate gets a DRE during their annual physical. I haven’t studied the literature regarding the accuracy of the test and I doubt a DRE catches every case of cancer but certainly if it can detect a single case, then I guess it has done its job. I do believe it must be accompanied with lab work and a discussion with respect to trends seen in the lab work over a period of time. No doubt imagery is the gold standard but is there enough resources for this level of care for everyone every year?

Like it or not routine DREs are a thing of the past, unless a patient presents with specific problems; e.g. difficulty voiding, weak stream or even ED. Otherwise it’s just simpler to order a PSA test along with other routine bloodwork.

I wonder if it wasn't in such a precarious location .....if they would still be so willing to stop examining it ?

I recall this topic coming up 4-5 years ago before my (male) urologist retired. I asked for his take on the topic of DREs since he had been doing them on me without fail every year I had seen him(about 15 years). He said thhe considered the DRE to be the 'gold standard' & that he could detect abnormalities in a prostate just by touch during an exam which he would then supplement with other tests. I told him I trusted his medical judgment & we continued the routine until he retired. Since he retired about four years ago, I have received my exams from a young woman PA-C (I'm in my 70s & she's probably in her 30s). She was taught by him & others & I don't have anything she hasn't seen as a medic. If & when I present with symptoms that she needs the consultation & advice of others, that's what will happen.

If best research supports a DRE, I'll trust a health provider to do so. I won't alter going to an exam just because it's unpleasant. I'd prefer to catch problems before they become major ones.