•  Colorectal Cancer •  Digestive Disorders Center •  Digital Rectal Exam for Prostate Cancer

A digital rectal exam (DRE) is a simple, potentially life-saving procedure. It's also something that most people would rather avoid. If your doctor recommends a DRE, try to put your squeamishness aside and look at the big picture. A few moments of discomfort could be the key to a healthy future.

The exam is very straightforward: Your doctor will slide a gloved, well-lubricated finger into your rectum to feel for anything out of the ordinary, such as lumps or hardness that may indicate a hidden condition. It lasts less than a minute and usually doesn't cause any pain, although there might be some slight soreness afterwards.

The digital rectal exam is a valuable tool against two deadly diseases: colorectal cancer and prostate cancer. With luck, the exam can help doctors detect these diseases in their earliest, most treatable stages.

When screening for rectal cancer, your doctor feels for growths on the lining of the rectum. The technique can detect both precancerous polyps and full-blown tumors.

If you're a man, your doctor can use the DRE to check your prostate gland for unusual swelling, lumps, or areas of hardness, all potential red flags for cancer. If your prostate is larger than normal, you may have benign prostatic hyperplasia, a very common, noncancerous condition that can make it difficult for you to urinate. If your prostate is tender when it's touched, the gland may be infected, a condition called prostatitis.

Digital rectal exams are helpful, but they can't tell your doctor everything. In most cases, a doctor will run additional tests to get the full story.

Because fewer than 10 percent of all colorectal cancers occur within reach of a finger, your doctor may want to combine a DRE with a test that looks for blood in your stool (fecal occult blood test). He or she may also order a colonoscopy or sigmoidoscopy (in which a flexible tube with a tiny camera on the end is used to explore the colon), or have a barium enema x-ray taken. If the DRE detects a growth, your doctor will order further tests to see if it's a polyp or a tumor.

Sometimes tumors on the prostate gland can also lie just out of reach. The American Urological Association recommends combining the DRE with the prostate specific antigen (PSA) blood test. If either of these test results are abnormal, the doctor can collect a biopsy, or sample, of the prostate for further testing.

Because rectal cancer and prostate diseases are rare in people under 40, young patients usually don't need digital rectal exams. Some gynecologists conduct DREs as part of a routine pelvic exam in young women, but a study published in the Journal of Family Practice in 1998 found that this practice rarely uncovers any hidden disease.

There are some cases where DRE may be appropriate for young patients. People with a family history of adenomatous polypopsis, a rare inherited form of cancer, may need to start screening as early as age 10. Also, anyone over 25 who has symptoms of colon cancer may need a DRE along with a colonoscopy or other test.

Experts disagree on the need for DRE for patients with no symptoms and no family history of colon cancer. At one extreme, the American Cancer Society recommends annual DREs for anyone over 50 who has no major medical problems and for those over 45 who are at high risk. The US Preventive Services Task Force, an independent group of experts that reviews the value of medical tests for the US Public Health Service, declined to endorse DREs at any age, saying "there is insufficient evidence to recommend for or against routine screening with digital rectal examination." Instead, the task force advocates fecal occult blood testing and/or sigmoidoscopy in people 50 and over.

You can cut through the confusion by talking to your doctor. If he or she recommends a DRE to screen for rectal polyps or cancer, find out why. If you're over 40 and your doctor hasn't suggested a DRE, find out why not. Working together, you can develop a sensible, workable approach to screening.

The picture for prostate screening is a bit clearer. According to the American Urological Association, most men should undergo annual DREs and PSA tests starting at age 50. African Americans and men with a family history of prostate cancer -- two groups at especially high risk for the disease -- should start annual testing at age 40.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

References

First published August 27, 2001
Last updated April 24, 2007
Copyright © 2001 Consumer Health Interactive

Or Find More On:

Back to top of page