Rectal examination adds little when PSA testing is available for prostate cancer screening
A comprehensive review indicates that a rectal examination provides no additional benefit beyond the PSA blood test in the screening process for prostate cancer. The conclusion comes from an analysis of multiple studies published in a peer reviewed journal focused on urology oncology. The result challenges the routine use of physical rectal checks as part of initial screening, especially when PSA testing already offers a clearer signal of potential risk.
Prostate cancer screening commonly relies on two well known methods: a digital rectal examination and PSA testing. PSA is a protein produced by the prostate, and higher levels can suggest cancer, though false positives and overdiagnosis remain concerns. While many men undergo PSA testing as a standard health measure, a substantial number do not participate in rectal screening, which has historically been used to feel for abnormalities in the prostate. In routine practice, PSA testing is the more frequently pursued method, and clinicians weigh results alongside overall health, symptoms, and family history to decide on the next steps.
In the current meta analysis, researchers combined data from eight separate studies, including a total of 85,738 men. The combined results show that performing rectal examinations alone, or in combination with PSA testing, does not detect additional cases of prostate cancer beyond what PSA testing achieves on its own. These findings suggest that the routine inclusion of a rectal exam adds little value in screening. The authors note that removing rectal examination from standard protocols could be reasonable when there are no clinical symptoms or signs that require closer investigation, potentially simplifying the process and reducing unnecessary discomfort for patients.
The study authors emphasize that PSA testing remains a key tool for identifying potential prostate cancer risk, with interpretation guided by age, baseline PSA levels, and other clinical factors. They also acknowledge limits in screening programs, such as the possibility of overdiagnosis and the challenge of distinguishing slow growing tumors from those that require treatment. In light of these observations, clinicians may rethink the routine use of rectal examination in asymptomatic men who are screened primarily by PSA results, reserving rectal checks for cases where clinical symptoms or signs warrant a more thorough physical assessment.
Beyond the debate about DRE and PSA, researchers continue to explore better ways to detect prostate cancer early. Advances in imaging, risk stratification, and biomarker discovery hold promise for more precise screening strategies, aiming to reduce unnecessary procedures while catching clinically significant cancers earlier. As new evidence emerges, guidelines may adapt to reflect the most reliable approaches for diverse populations in North America, including the United States and Canada, where screening practices vary by age, risk factors, and access to care. In the meantime, men are encouraged to discuss their individual risk with healthcare providers and to make informed decisions that align with their health goals and preferences, ensuring that screening choices are grounded in current evidence and personalized care. [citation: meta-analysis of eight studies including 85,738 men; conclusions drawn by urology oncology researchers]