Objective: To help students, residents, and general practitioners to improve the technique, skills, and reproducibility of their prostate examination.
Methods: We developed a comprehensive guideline outlining prostate anatomy, indications, patient preparation, positioning, technique, findings, and limitations of this ancient art of urological evaluation.
Results: The prostate exam was the first diagnostic test used for prostate cancer screening and other urological conditions. Although several alternative procedures have been developed in the past century, the prostate exam is still an important part of genital–pelvic evaluation because of its simplicity, cost and time effectiveness, and relatively minimal patient discomfort experienced.
Conclusion: With an aging population and increasing incidence of prostate diseases, it is imperative that healthcare professionals possess the knowledge, skills, and attitudes to make the prostate exam a routine part of a complete physical examination.
PopadiukCPottleMCurranV. Teaching digital rectal examinations to medical students: An evaluation study of teaching methods. Acad Med, 2002: 77: 1140–1146.
6.
GrayH. The prostate (prostata; prostate gland). In: GrayH, Gray’s Anatomy of the Human Body (20th edition). Philadelphia, PA: Lea & Febiger, 1918. Online. Available: http://www.bartleby.com/107/263.html (18 January 2011).
7.
SobinLHGospodarowiczMKWittekindC. International Union Against Cancer. Classification of Malignant Tumours (7th edition). Oxford: Blackwell Publishing Ltd, 2010.
RomeroFRRomeroKRBrennyFTPilatiRKulyszDde Oliveira JúniorFC. Reasons why patients reject digital rectal examination when screening for prostate cancer. Arch Esp Urol, 2008: 61(6): 759–765.
10.
MessinaLELimaHAndradeEPintoGASrougiMOrtizV. Estudo da preferência da posição que urologistas brasileiros utilizam para realizar o toque prostático [Study on the preferred position Brazilian urologists use for prostate exam]. In: 30 Congresso Brasileiro de Urologia, 2005, Brasilia. Anais do Congresso (vol. 30). Rio de Janeiro: Press Graphic & Publishing Ltd, 2005, p. 19.
11.
KontturiM. Symptoms and patient evaluation. In: AltweinJE (Ed) Benign Prostatic Hyperplasia: A Diagnosis and Treatment Primer. New York: Merck & Co, Inc., 1994, pp. 55–56.
12.
FrankJThomasKOliverS. Couch or crouch? Examining the prostate: A randomized study comparing the knee-elbow and the left-lateral position. BJU Int, 2001: 87: 331–333.
13.
FurlanABKatoRVicentiniFCuryJAntunesAASrougiM. Patient’s reactions to digital rectal examination of the prostate. International Braz J Urol, 2008: 34(5): 572–575.
14.
CampbellMF. Urologia prática [Practical urology]. Rio de Janeiro: Guanabara Koogan, 1960, pp. 41–45.
15.
RomeroFRRomeroAWBrenny FilhoTBarkNMYamazakiDSde OliveiraFC. Patients’ perceptions of pain and discomfort during digital rectal exam for prostate cancer screening. Arch Esp Urol, 2008: 61(7): 850–854.
16.
LaneTJ. A note on rectal examination of the adenomatous prostate. Ir J Med Sci, 1940: 15(7): 322–326.
17.
HinmanF. Rectal examination of prostate and seminal vesicles. In: HinmanF, The Principles and Practice of Urology. Philadelphia and London: WB Saunders Company, 1935, pp. 303–305.
18.
LoebSHanMRoehlKAAntenorJACatalonaWJ. Accuracy of prostate weight estimation by digital rectal examination versus transrectal ultrasonography. J Urol, 2005: 173: 63–65.
19.
RoehrbornCGGirmanCJRhodesT. Correlation between prostate size estimated by digital rectal examination and measured by transrectal ultrasound. Urology, 1997: 49: 548–557.
20.
TalleyNJ. Should we examine the prostate prior to colonoscopy?Am J Gastroenterol, 2009: 104(1): 247–247.
21.
PeelingWB. Patient selection and evaluation: Investigation. In: ChisholmGD (Ed) Handbook on Benign Prostatic Hyperplasia. New York: Merck & Co, Inc., 1994, pp. 54–55.
22.
CatalonaWJRichieJPAhmannFR. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: Results of a multicenter clinical trial of 6,630 men. J Urol, 1994: 151(5): 1283–1290.
23.
HansenJGJr.DalkinBLHarrisCHJohnsonCSAhmannFR. Prostatic asymmetry as a risk factor for prostatic carcinoma: Serial prostate-specific antigen monitoring and cancer detection. Br J Urol, 1997: 79: 924–926.
24.
GrossfeldGDCarrollPR. Prostate cancer early detection: A clinical perspective. Epidemiol Rev, 2001: 23(1): 173–180.
25.
MistryKCableG. Meta-analysis of prostate-specific antigen and digital rectal examination as screening tests for prostate carcinoma. J Am Board Fam Pract, 2003: 16: 95–101.
26.
NaglerHMGerberEWHomelP. Digital rectal examination is barrier to population-based prostate cancer screening. Urology, 2005: 65(6): 1137–1140.
27.
GosselaarCRoobolMJRoemelingSvan der KwastTHSchroederFH. Screening for prostate cancer at low PSA range: The impact of digital rectal examination on tumour incidence and tumour characteristics. Prostate, 2007: 67(2): 154–161.
28.
RifkinMD. Endorectal sonography of the prostate: Clinical implications. AJR, 1986: 148: 1137–1142.
