Digital Rectal Examination and Prostate-Specific Antigen
        Benefits
        Harms

Note: Separate PDQ summaries on Prevention of Prostate Cancer, Prostate Cancer Treatment, and Levels of Evidence for Cancer Screening and Prevention Studies are also available.

The evidence is insufficient to determine whether screening for prostate cancer with prostate-specific antigen (PSA) or digital rectal exam (DRE) reduces mortality from prostate cancer. Screening tests are able to detect prostate cancer at an early stage, but it is not clear whether this earlier detection and consequent earlier treatment leads to any change in the natural history and outcome of the disease. Ecological evidence shows a trend toward lower mortality for prostate cancer in some countries, but the relationship between these trends and intensity of screening is not clear and associations with screening patterns are inconsistent. The observed trends may be due to screening, or to other factors such as improved treatment.[1]

Levels of Evidence

A. Study Design (Levels of Evidence 4, 5)

4: Evidence obtained from ecologic and descriptive studies (e.g., international patterns studies, time series).

5: Opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.

B. Internal Validity: Poor.

C. Consistency: Poor.

D. Direction and Magnitude of Effect: Uncertain.

E. External Validity: Poor.

Based on good evidence, screening with PSA and/or DRE detects some prostate cancers that would never have caused important clinical problems. Thus, screening leads to some degree of overtreatment. Based on good evidence, current prostate cancer treatments, including radical prostatectomy and radiation therapy, result in permanent side effects in many men. The most common of these side effects are erectile dysfunction and urinary incontinence.[1-3]

Levels of Evidence

A. Study Design (Level of Evidence 3)

3: Evidence obtained from cohort or case-control studies.

B. Internal Validity: Good.

C. Consistency: Good.

D. Direction and Magnitude of Effect: 20% to 70% of men who had no problems before radical prostatectomy or external-beam radiation therapy will have reduced sexual function and/or urinary problems.[1]

E. External Validity: Good.

References

1. Harris R, Lohr KN: Screening for prostate cancer: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137 (11): 917-29, 2002.  [PUBMED Abstract]
   
   
2. Litwin MS, Pasta DJ, Yu J, et al.: Urinary function and bother after radical prostatectomy or radiation for prostate cancer: a longitudinal, multivariate quality of life analysis from the Cancer of the Prostate Strategic Urologic Research Endeavor. J Urol 164 (6): 1973-7, 2000.  [PUBMED Abstract]
   
   
3. Steineck G, Helgesen F, Adolfsson J, et al.: Quality of life after radical prostatectomy or watchful waiting. N Engl J Med 347 (11): 790-6, 2002.  [PUBMED Abstract]
   
   

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