In the era of MRI and other advanced imaging, do you still routinely perform a digital rectal exam on every prostate cancer patient?

Having started my career in the era when the latest in advanced imaging was a first generation CT scan, I still perform DRE on every patient at consultation (unless they refuse). There are several reasons for this approach. First, the information you get from DRE is needed for staging purposes, which becomes an issue for cancer centers needing to maintain accreditation, not to mention treatment decisions. Second, most newly diagnosed patients that I see have not been imaged locally beyond a TRUS-guided biopsy, and one can get important information inexpensively and quickly from DRE, such as an estimation of prostate size, that can guide discussion of options. For example, if brachytherapy is under consideration, the finding of an enormous p...

My practice is different than @Dr. First Last has outlined. The vast majority of men that I see in consultation have had a mpMRI in addition to the TRUS. In my experience, the DRE rarely changes management and I perform DRE at initial consultation in a minority of men. I also see many men for discussion of postprostatectomy XRT and the only time that I perform a DRE is when the PSA is above 1-2 and/or the interval from RP is long. I hardly ever do a DRE in follow-up; as @Dr. First Last said many years ago, the PSA is judge and jury. Of course in patients with symptoms suggestive of prostatitis, etc it is reasonable to perform.

As Mitch suggests the DRE is "cheap" but in my view, it rarely provides meaningful information.

Not sure what this obsession is with DRE in this current era of high-quality imaging. People were even talking about this before the era of high-quality imaging (https://www.ncbi.nlm.nih.gov/pubmed/11586202).

But the reason I wanted to comment was based on the statement "First, the information you get from DRE is needed for staging purposes, which becomes an issue for cancer centers needing to maintain accreditation, not to mention treatment decisions." So that is not technically correct. DRE factors into clinical staging but is not the only method for clinical staging. Essentially every prostate cancer patient gets an ultrasound-guided biopsy (maybe MRI nowadays) before being diagnosed with prostate cancer. As the American Cancer Society sa...

Interesting discussion. I agree that a DRE at baseline is a useful test. The DRE is notoriously unreliable between different examiners, even when they are experienced urologists. Thus, a previous DRE performed by a urologist isn't the same as "truth" necessarily. (Interobserver consistency of digital rectal examination in clinical staging of localized prostatic carcinoma. Angulo JC, Montie JE, Bukowsky T, Chakrabarty A, Grignon DJ, Sakr W, Shamsa FH, Edson Pontes J. Urol Oncol. 1995;1:199-205.)

However, my comment has more to do with DRE in the follow-up situation after definitive RT. Based upon a study by Doneaux A...Dearnaley D, I think one can safely refrain from DRE to assess for local recurrence after RT unless the PSA is elevated above...

In follow up, I generally do a rectal exam at least once a year checking for occult blood that may hint of late radiation effects. Also, I picked up a low-lying rectal cancer on a prostate cancer patient during follow up 5 years later.

I continue to recommend digital rectal examination at the initial consultation with any prostate cancer patient. In the intact setting this is certainly useful for staging. In addition, I practice in an area where a large percentage of the patients have never undergone colon cancer screening so I also include referral for colonoscopy as part of my normal initial prostate cancer evaluation as well when this has not been done. It also provides an opportunity to identify other potential issues such as internal/external hemorrhoids which may contribute to reported side effects during radiation such as prior blood per rectum.

I have decreased the frequency of examinations during followup and generally perform one annually, if not performed by ano...