Is there a role for digital rectal examination in the followup of patientsafter radical prostatectomy?

Purpose: We determine the role of digital rectal examination in the followu p of patients after radical prostatectomy Materials and Methods: We retrospectively analyzed data on 501 consecutive patients who underwent radical retropubic prostatectomy between 1992 and 19 98, and were followed at the University of Miami. Patients were evaluated a t 3 to B-month intervals after surgery with serum prostate specific antigen (PSA) and digital rectal examination. Biochemical recurrence was defined a s PSA greater than 0.2 ng./ml. and increasing on at least 2 consecutive mea surements. Local recurrence, detected by an abnormal digital rectal examina tion, was defined as an induration or nodularity in the prostatic fossa. Results: Mean followup plus or minus standard deviation was 25.4 +/- 20.8 m onths. Disease recurred in 72 patients (14.4%) and was biochemical in all. An abnormal digital rectal examination was noted in 4 patients, none of who m had an undetectable PSA at the time of a palpable abnormality. Conclusions: Our results suggest that an abnormal digital rectal examinatio n after radical prostatectomy is always associated with a detectable PSA, w hich implies that performing a digital rectal examination in the absence of a detectable PSA may not be necessary.