Efficacy of digital rectal examination after radiotherapy for prostate cancer

Purpose: Digital rectal examination is widely performed for following patie nts with localized prostate cancer after definitive therapy. This examinati on has marginal efficacy for detecting initial prostate cancer and postoper ative recurrence. To determine the efficacy of digital rectal examination i n terms of new information provided after radiotherapy we analyzed the resu lts of digital rectal examination in the followup of patients with prostate cancer after radiotherapy. Materials and Methods: We performed a nonrandomized study in 235 consecutiv e patients with prostate cancer followed at a large tertiary care military hospital between January 1, 1995 and December 31, 1999. All patients had be en treated with prostate radiotherapy and had no evidence of metastatic dis ease at the first visit within that interval. Digital rectal examination wa s done at followup and the main outcome measure was new information provide d by that examination. Results: A total of 1,544 digital rectal examinations were performed in 1,6 27 visits. New information was provided by digital rectal examination in on ly 30% of 286 abnormal examinations, of which more than three-quarters were related to bleeding and would otherwise have been noted on routine examina tion by the primary care provider. All 8 persistent recurrent prostate nodu les were noted in the context of increasing prostate specific antigen. Conclusions: Routine digital rectal examination in patients with prostate c ancer after radiotherapy may be omitted from followup protocols.