They also found the combination of an excessively high PSA level, accompanied by an abnormal finding digital exam, to be a highly accurate predictor of cancer on biopsy.

But the researchers also found that in men with normal, low PSA levels, the positive predictive value of digital rectal exam ranged from 4% to 11%, increasing to as high as 83% in those with high PSA levels. The researchers also note that men with low PSA levels who do have prostate cancer “usually harbor prostate cancer that has a favorable prognosis.”

The European authors conclude that, for men with normal PSA levels, “the digital rectal exam should be replaced with a more sensitive test.”

But in an accompanying commentary, two US experts at the University of Texas Health Sciences Center at San Antonio contend that they will “continue to recommend both PSA and digital rectal examinations.”

Drs. Joseph Basler and Ian Thompson point out that, according to the European study, digital exams were instrumental in alerting physicians to the 17.3% of all prostate tumors found in men with otherwise ‘normal’ PSA levels. “The facts that one quarter to one third of all prostate cancers are detected by digital rectal exam in the ‘normal’ PSA range (and) that digital rectal exam is not viewed by patients as an impediment to screening… make it a reasonable companion to PSA in current programs for prostate cancer screening,” they conclude.

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