Are doctors examining prostates in university hospital?

We have observed that serum prostate-specific antigen (PSA) testing is commonly performed for prostate assessment or screening but use of digital rectal examinations (DREs) appears inconsistent. To better define suspected underperformance of DRE, we studied the frequency of combining DRE with PSA testing in prostate assessment.

We performed a retrospective study of 197 consecutive patients at a single institution from January 2004 to June 2005 for whom an in-patient urologist consultation was requested. The inclusion criteria were male patients aged 50 years or older with no history of prostate cancer. The mean age of the patients was 62.4 years. Documentation of DREs and PSA testing, reasons for the urologist consultation, and the teams responsible for the patient's hospital care were assessed by a single chart reviewer familiar with the setting and format of the hospital medical records.

A total of 89 patients (45.18%) had PSA test results, 50 (25.38%) had DRE findings, and 34 (17.26%) had both DRE findings and PSA test results documented in the hospital medical record during their admission before the urologist consultation. Of 68 surgical patients, 22 (32.35%) had undergone DRE compared with 28 medical patients (21.71%). More medical patients had had PSA testing than had surgical patients (48.06% versus 39.88%).

Prostate cancer assessment or screening by combining DRE with PSA testing is often not done by doctors in a teaching university hospital. The underperformance of DRE not only deprives junior doctors of training but also leads to nondetection of some prostate cancer cases.