What is the role of digital rectal examination in men undergoing serial screening of serum PSA levels?

This Practice Point commentary discusses the study by Gosselaar et al. that reports the performance characteristics of digital rectal examination (DRE) in men from the Rotterdam cohort of the European Randomized Study of Screening for Prostate Cancer. The authors reported that the positive predictive value of DRE for detecting the presence of prostate cancer was 48.6% in the first round of screening, decreasing to 29.9% and 21.2% in the second and third rounds, respectively. Nevertheless, an abnormal DRE was associated with a significantly increased risk of very high-grade disease during all screening rounds, indicating that it provides useful additional prognostic information. This study adds to a considerable body of evidence supporting a role for DRE in early detection of prostate cancer.