Generality
Digital rectal exploration of the prostate consists of palpation of the prostatic surface through the introduction of the gloved index finger in the patient's anus.
This operation is carried out by a doctor specializing in urology and is essential for the diagnostic assessment of prostate cancer.
Why it runs
Together with the blood dosing of prostate-specific antigen (PSA), digital rectal exploration of the prostate represents a first-level investigation to identify subjects who presumably, although not necessarily, have developed prostate cancer. In this sense, the diagnostic confirmation or denial can only come from the results of a further examination, the prostatic biopsy, during which small samples of prostate tissue are taken to be examined in the laboratory.
Sensitivity and Specificity
Digital rectal exploration of the prostate is not a particularly pleasant experience, but neither is it so burdensome or embarrassing. It is carried out in just a few minutes and concretely increases the chances of discovering a prostate cancer at an early stage, although to be honest it is a test that is anything but infallible.
The purpose of the procedure is the tactile perception of enlargements, irregularities, knots and increases in consistency (hardness) of the gland, which allow a healthy prostate to be distinguished from benign prostatic hypertrophy and prostate cancer. Unfortunately, however, digital rectal prostatic exploration remains an imprecise examination, although still very useful. Despite the good specificity, due to the often contained tumor size or a location unreachable with digital rectal exploration, the ability to identify sick subjects is reduced; on average, in fact, out of 100 prostatic cancers only 20 are found at palpation.
When to do it
If you are over 45/50 years old, especially in the presence of close relatives (children, fathers, siblings) suffering from prostate cancer, contact your doctor to evaluate the opportunity of an annual urological examination of digital prostatic rectal exploration, combined with serum PSA dosage.
Not all physicians agree that this screening approach (PSA + digital exploration) is useful in asymptomatic subjects or those without important risk factors; in fact, this procedure involves some significant risks:
- the risk of having to undergo an invasive investigation such as a biopsy for a false alarm (subjects who on the basis of PSA values or suspicions emerging from digital rectal prostate exploration seem to be sick, when in reality they are revealed to biopsy healthy);
- having to undergo, in the case of a positive biopsy, a therapeutic intervention for a "latent" form that would have remained inert for the rest of life, with all the psychophysical repercussions (risk of erectile dysfunction and incontinence) linked to the intervention.
