DEAR DR. ROACH:
I am a 77-year-old male and have not had a rectal exam for three years. My newest physician says it is not necessary, in light of my PSA exams over the past six years. (The result of the last one in March was 0.2 ng/mL.) I have had this doctor, who is in his 50s, for one year. My previous doctor, who was in his 80s, always did a digital rectal examination (DRE) yearly. I am concerned that a DRE is necessary. — G.L.
ANSWER:
A rectal exam very rarely makes a diagnosis of prostate or rectal cancer when the PSA test (in the case of prostate cancer) or the colon exam (for colorectal cancer) is normal. This recommendation is fairly recent. Your PSA level is very low, putting you at an extremely low risk.
There’s not much harm of a rectal exam, and I perform them on my patients who feel their exams are incomplete without it. But most men don’t really want them, and a few simply refuse.
Prostate cancer screening is appropriate for men who have at least a 15-year life expectancy. Several decision analyses have suggested more harm than benefit for PSA screening in most men over 70, since they get all the harm right away and only receive benefit after 10-15 years.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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