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digital rectal examination (DRE)

Indications: 1) anal pain, perianal pain or abdominal pain 2) rectal bleeding 3) anorectal mass 4) perianal pruritus 5) fecal incontinence 6) constipation 7) weight loss [7] 8) allows for assessment of anal sphincter tone 9) allows for testing of fecal occult blood 10) initial evaluation of anorectal dyssynergia [10] Contraindications: 1) NOT a reliable screen for prostate cancer [3,6] - may allow for estimate of prostate size 2) not a useful screen for colorectal carcinoma [3] a) allows for examination of only part of the rectum b) sensitivity 5% for detection of advanced neoplasia* [4] 3) evidence is mixed on whether digital rectal exam is beneficial alone or in combination with serum PSA [5] * tubular adenoma > 10 mm, villous adenoma, high-grade dysplasia or colorectal cancer * DRE superfluous with use of MRI during active surveillance of prostate cancer [8] Procedure: - video [7] - requires explicit consent [9] Notes: - does NOT significantly affect serum prostate-specific antigen (PSA) - hospitals performing digital rectal exams with explicit patient consent will not be eligible for Medicare & Medicaid reimbursement [7]

Related

fecal occult blood; fecal immunochemical testing; fecal immunofluorescence testing, multitarget stool DNA (mt-sDNA, FOB, FIT, iFOBT, ColonCARE, Hemoccult, ICT, InSure) screening for colon cancer screening for prostate cancer

General

clinical procedure

References

  1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. US Preventative Services Task Force
  4. Journal Watch 25(4):30, 2005 Collins JF, Lieberman DA, Durbin TE, Weiss DG; Veterans Affairs Cooperative Study #380 Group. Accuracy of screening for fecal occult blood on a single stool sample obtained by digital rectal examination: a comparison with recommended sampling practice. Ann Intern Med. 2005 Jan 18;142(2):81-5. Summary for patients in: Ann Intern Med. 2005 Jan 18;142(2):I23. PMID: 15657155
  5. Qaseem A et al Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 9 April 2013 PMID: 23567761 http://annals.org/article.aspx?articleid=167618
  6. Naji L, Randhawa H, Sohani Z, et al Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis. Ann Fam Med March/April 2018 vol. 16 no. 2 149-154 PMID: 29531107 Free full text http://www.annfammed.org/content/16/2/149
  7. Rajab TK, Bordeianou LG, von Keudell A et al Digital Rectal Examination and Anoscopy. N Engl J Med 2018; 378:e30. May 31, 2018 PMID: 29847759 https://www.nejm.org/doi/full/10.1056/NEJMvcm1510280
  8. Remaly J Omit Digital Rectal Exam in Prostate Cancer Surveillance? Medscape. February 06, 2023 https://www.medscape.com/viewarticle/987915
  9. Merelli A New HHS guidance requires consent for pelvic, breast, and other sensitive examinations. STAT. April 1, 2024 https://www.statnews.com/2024/04/01/informed-consent-pelvic-exam-new-hhs-guidelines/
  10. Tantiphlachiva K, Rao P, Attaluri A, Rao SS. Digital rectal examination is a useful tool for identifying patients with dyssynergia. Clin Gastroenterol Hepatol. 2010 Nov;8(11):955-60. PMID: 20656061