A large European study finds that digital rectal exams to screen for prostate cancer are most likely to miss cancers when the results of prostate-specific antigen (PSA) blood tests — another screening test — are in the low numbers (less than 4.0 ng/mL).

However, American experts believe the rectal exam is still essential for detecting cancers otherwise missed by PSA screening. The report and editorial are published in the December 2nd issue of the Journal of the National Cancer Institute.

Prostate cancer is the second leading cancer killer of men (after lung cancer) in the United States. For decades, annual digital rectal examinations in men over 50 years of age have been the primary recommendation for early detection of prostate tumors. The advent of prostate-specific antigen blood testing — which measures levels of an antigen linked to prostate cancer — has helped raise detection rates to even higher levels in recent years.

In their study of over 10,000 men, the European group examined the accuracy of the digital rectal exam alone, and compared with its use in combination with the PSA test.

They discovered that while 4.5% of screenings involving both tests resulted in cancer detection, this rate fell to just 2.5% when physicians relied on the digital exam alone.

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