Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis

This article is spot on. The two comments prior to mine that disagree with the author's recommendation fail to consider that, a) we have limited time in the exam room, and b) the time spent on a DRE can be spent on higher yield activities. While it is true that virtually any exam component, including the rectal exam, may uncover a high risk malignancy once in a blue moon, you have to do the exam on hundreds if not thousands of patients before that will typically occur. If you spend those same 60 seconds or so with each patient on more detailed and meaningful counseling about diet, exercise, and other health related education, you will have a much greater positive impact on a much higher percentage of patients. Thanks to well designed studies like this one, the role of the physician is slowly shifting, as it should. Our role should NOT be to do thousands of invasive exams per year on a quest to find zebras. Instead, it should be to spend the limited time we have educating patients in a meaningful way on how to BE HEALTHY! My annual physical with each patient involves a problem-focused, and otherwise cursory physical exam, and the rest of the visit is spent counseling patients in detail on exercise and especially diet, to cure and avoid the diseases that kill the most Americans. And my patients love this approach. Evidence based recommendations like this one, which help us avoid wasting the precious little time we have in the exam room, should be embraced!

Competing interests: None declared