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Pradip Javle concludes that digital rectal examination is of no use in diagnosing prostate cancer (News, May 14).

Feeling a firm and hard prostate does not equate to prostate cancer but, together with raised levels of PSA, it is suggestive and the patient should be referred for trans-rectal ultrasound (TRUSS) guided biopsy.

There are no charateristic signs of cancer on ultrasound hence multiple biopsies may be required before cancer is picked up.

Without doing a DRE one would treat on the basis of symptoms, not knowing the actual size or consistency and urgent referral may be missed. Leach et a · 1 suggest PSA along with DRE is the accepted practice for prostate cancer screening in the USA.

A further study in Washington is evaluating PSA and DRE in 38,350 men for Ca prostate in a clinically valid manner.

We must not change the way we practise until the results are released.

Dr IM Ali, GPwSI in Urology, Chatham, Kent

1. Cancer Biol.Ther; 2005, April 28, F.S.Leach et al

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