A 164-patient retrospective found suspicious DRE was present in 48.5% of clinically significant prostate cancer cases and correlated with advanced pathological stage (≥pT3)
Journal: The Prostate | Published: 2026-03-03 | Type: Retrospective Analysis | PMID: 41773708 Authors: Eker Anil et al. (Department of Urology, Izmir City Hospital, Turkey — multiple departments including Nuclear Medicine and Radiology) Funding/COI: Funding not listed; authors declare no conflicts of interest
As mpMRI and PSMA PET/CT have become standard in prostate cancer workup, digital rectal examination has quietly been sidelined. This single-institution Turkish study pushes back, finding that a suspicious DRE correlated significantly with higher PI-RADS scores, larger lesion size, elevated SUVmax on PET/CT, and advanced pathological stage after prostatectomy. The authors argue DRE remains a useful adjunct for risk stratification — not screening — when read alongside modern imaging. The caveat: this is a retrospective study of patients already known to have cancer, which limits how far those conclusions can travel.
This is a retrospective single-center study of 164 patients who were already biopsied and confirmed to have prostate adenocarcinoma. That's the central methodological problem: the sample is pre-selected cancer patients, so DRE's sensitivity and specificity numbers here say nothing about how DRE performs in a general population presenting with elevated PSA. The study is measuring how well DRE identifies high-risk cancer among patients already known to have cancer, which is a narrower — and easier — task than screening.
The PSMA PET/CT subgroup is only 62 patients, too small to draw firm conclusions about SUVmax thresholds. DRE is inherently operator-dependent, and the study involved multiple urologists performing exams; no inter-rater reliability data are reported. The methods section has an unexplained anomaly: the ethics committee and hospital names are redacted as "XX, YY Hospital," which is unusual for a published paper and raises minor questions about pre-publication preparation.
This paper makes a defensible case that DRE still adds information in patients with known prostate cancer — specifically that a positive exam correlates with tumor bulk and extraprostatic extension. That's useful for risk stratification. But the study's design cannot support the broader claim that DRE "deserves continued integration into the diagnostic pathway" for prostate cancer detection generally. A 164-patient, single-center, already-diagnosed cohort is not the evidence base for a policy recommendation. Worth reading as hypothesis-generating; treat the thresholds (13.5 mm, SUVmax 15.1) as preliminary until validated in a prospective unselected population.