GPs advised to follow NICE on hypertension
Emma Wilkinson reports on new research focusing on the problems GPs face in diagnosing cancer
Digital rectal examination is of no use for the diagnosis of prostate cancer and should not be used routinely
by GPs, a controversial new study concludes.
Researchers found no relationship between abnormal digital rectal examinations and diagnosis or staging of cancer. They branded the test 'a waste of time' and said GPs should no longer do it before testing for PSA.
GPs reacted cautiously, warning the findings should not be seen as a green light to rely more heavily on PSA.
In the study, only 47 per cent of 196 patients with abnormal digital rectal examination had cancer on biopsy, and 28 per cent of those with normal examinations.
Overall, abnormal examination predicted the presence of cancer with an accuracy of only 60 per cent and did not predict cancer stage.
Study leader Mr Pradip Javle, consultant urologist at Leighton Hospital in Crewe, said: 'In a man in his late 40s coming to a GP with symptoms, you suspect prostatic enlargement so you do PSA tests. Carrying out digital rectal examination would not change your management. It makes no difference to what you do.'
Mr Javle said that in men with elevated PSA, doing digital rectal examination was 'a waste of time'. He argued it was only necessary to do an examination if PSA was normal but there were unexplained symptoms.
Dr Nick Brown, a GP in Chippenham and cancer lead for Kennet and North Wiltshire PCT, said: 'The trouble is I suspect most patients will have digital rectal examination before their PSA. I'm sure we'd be pleased if people didn't want us to do it but there's a timing issue.'
Dr James Kingsland, member of the scientific reference group on prostate cancer screening and a GP in Wallasey, Merseyside, said he was worried about GPs getting mixed messages. 'Hospital doctors don't have any experience of working in the community. What we need is a test that fits screening criteria and PSA doesn't. Diagnosis of prostate cancer is still unclear,' he said.
The study, published in BJU
International (May), audited 408 patients referred to a urology clinic with PSA levels of between 2.5 and 10ng/ml, 152 of whom were diagnosed with cancer.