SCREENING DIGITAL RECTAL EXAMINATION AND PROSTATE-CANCER MORTALITY - A POPULATION-BASED CASE-CONTROL STUDY

Objectives. Although digital rectal examination (DRE) for the detectio n of prostate cancer has been recommended by many professional groups and has become part of the general physical examination, no randomized clinical trial has demonstrated the efficacy or effectiveness of this practice. We conducted a population-based case-control study to evalu ate the association between DRE and prostate cancer mortality. Methods . With the resources of the Rochester Epidemiology Project, all 173 me n who died of prostate cancer in Olmsted County from 1976 to 1991, who were resident at the time of diagnosis, were identified. For each cas e, two control patients were drawn from the population, matched for re sidence at the time of diagnosis in the case, birth date, and duration of medical record in Olmsted County. Trained nurse abstractors review ed the community medical records for up to 10 years before the date of diagnosis in the case for mention of DRE and specific findings associ ated with each mention. Results. Case subjects were less likely than c ontrol subjects to have had any DRE in the 10 years before diagnosis ( matched odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.31, 0 .84). When limited to DREs without mention of signs or symptoms that m ight raise suspicion of prostate cancer, the association was even stro nger (OR = 0.31; 95% CI = 0. 19, 0.49). Adjustment for educational att ainment, marital status, and comorbid conditions did little to alter t he associations. Conclusions. These results demonstrate a strong inver se association between DRE and prostate cancer mortality. If further r esearch concludes this association to be causal, screening DREs may ha ve prevented as many as 50% to 70% of deaths due to prostate cancer th at.might have occurred in the absence of screening. UROLOGY 52 173-179 , 1998: (C) 1998, Elsevier Science Inc. All rights reserved.