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Principal Investigator
Name
Sanoj Punnen
Degrees
MD
Institution
University of Miami Miller School of Medicine
Position Title
Associate Professor
Email
About this CDAS Project
Study
PLCO (Learn more about this study)
Project ID
PLCO-671
Initial CDAS Request Approval
Oct 8, 2020
Title
Assessing the Risk and Cost of the Digital Rectal Exam: Is It Time to Abandon the DRE?
Summary
The COVID pandemic has brought dramatic, global change to healthcare on multiple levels, and as we adapt, we have been forced to re-evaluate how to streamline our care to the fit the new environment we are in. More and more of our encounters with patients are via telemedicine to prevent unnecessary contact. While this is vital to prevent the potential spread of the virus, it is also challenging because our diagnosis and management of your health can no longer rely on the physical exam. As a result, each medical specialty, including urology, has the unique opportunity to re-evaluate what exam components are important for assessing patient care, and which are not.

As urologists, we think the first exam that needs to be put on the chopping block is the digital rectal exam (DRE). In this new COVID telehealth world where the DRE is more inappropriate than it ever has been before, we have to ask ourselves whether the exam provides helpful clinical information, or we are potentially performing an ineffective, potentially harmful and costly exam.

Currently there is strong data supporting the poor sensitivity and specificity of the DRE. Using the PCLO data, a prior study also showed that only 2% of men with a positive DRE and normal PSA had clinically significant prostate cancer.[1] Despite this data, many urologists argue the exam does little harm and is a quick and relatively cheap screening tool, which is why the DRE is still widely accepted as a component of prostate cancer screening amongst urologists and is still performed regularly.

In response to this reasoning for the continued use of the DRE, we are interested in using the PLCO data to further explore the potential risks and overall costs of the DRE. With the PLCO data, we want to explore whether the DRE puts patients at increased risk for unnecessary prostate biopsies and the risks that come with them. We also want to perform a cost-analysis of DREs to see if they are as cost-effective as urologists believe they are. Specifically, we want to assess the clinical utility of the DRE in detecting prostate cancer and the risk of a positive DRE which results in a biopsy with benign results. We are also interested in a cost analysis of a positive DRE that results in a biopsy with benign results. Through this analysis, we hope to discover whether it is finally time to abandon the DRE for prostate cancer screening.

[1] T. Cui, R. C. Kovell, and R. P. Terlecki, "Is it time to abandon the digital rectal examination? Lessons from the PLCO Cancer Screening Trial and peer-reviewed literature," (in eng), Curr Med Res Opin, vol. 32, no. 10, pp. 1663-1669, Oct 2016, doi: 10.1080/03007995.2016.1198312.
Aims

-assess the clinical utility of the DRE in detecting prostate cancer
-assess the risk of a positive DRE which results in a biopsy with benign results
-perform a cost analysis of a positive DRE that results in a biopsy with benign results

Collaborators

Justin Dubin MD, University of Miami Miller School of Medicine
Ruben Blachman Braun MD, University of Miami Miller School of Medicine
Chad Ritch MD, University of Miami Miller School of Medicine