What is the value of digital rectal examination in patients with PSA < 3? And does performing the examination raise the PSA? If so, for how long?
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- Answered 15 Sep 2019 Conflict of interest declaration: None I posted this Q to Twitter and got a response  which pointed to this 2018 article “Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis”, this concludes: “Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.” The paper is available as full-text so you can read the detail via the link in the references section. This year NICE published “Prostate cancer: diagnosis and management”  and this discusses DRE in a number of places, again full-text is available via the link below. With regard the Q about does the DRE raise PSA, this 1999 paper “Effect of digital rectal examination on serum complexed and free prostate-specific antigen and percentage of free prostate-specific antigen”  which concludes: “In this study, DRE significantly increased total, calculated complexed, and free PSA and percent free PSA. The increase of PSA immediately after DRE was mainly due to the increase of free PSA. The change of percent free PSA after DRE depended on the initial percentage of free PSA. Complexed PSA seems less sensitive to DRE, and its changes after DRE were clinically modest. Free PSA measurement should be done before DRE and percent free PSA should be used only when the venipuncture is done before the DRE.” They later report: “According to Ornstein et al. and Woodrum et al., 24 to 48 hours are necessary for re-equilibration of PSA forms after DRE.” References 1) https://twitter.com/DanMcCarterMD/status/1172952250014212096 2) http://www.annfammed.org/content/16/2/149.full.pdf 3) https://www.nice.org.uk/guidance/ng131/resources/prostate-cancer-diagnosis-and-management-pdf-66141714312133 4) https://www.ncbi.nlm.nih.gov/pubmed/10565747