Patient's reactions to digital rectal examination of the prostate

Abstract

Objective: In recent years, there has been a rise in the incidence of prostate cancer (PCa), and routine screening for the disease has become a well accepted clinical practice. Even with the recognized benefit of this approach, some men are still reluctant to undergo digital rectal examination (DRE). For this reason, we designed the present study in order to better understand men's reactions about this method of screening. The aim was to identify possible drawbacks that could be overcome to increase DRE. Materials and Methods:We randomly selected 269 patients that were enrolled in an institutional PCa screening program. They were first asked to answer a question regarding their preferred position to undergo the examination. Following this step, they answered a questionnaire in which physical and psychological reactions regarding the DRE were presented. Finally, we used a visual analogical scale (VAS) to analyze the perception of pain during DRE.Results: The supine position was preferred for most patients (53.9%). Before DRE, about 59.4% of patients felt that the exam would be acceptable. After DRE, this figure increased to 91.5% (p < 0.001). Mean VAS score during DRE was 1.69 on a scale with a range between 0 and 10 (0 = no pain; 10 = extreme pain). Conclusion: Patient expectations about DRE were negative before examination and changed significantly following the exam. Pain during examination was negligible, contrary to the prevalent belief. These two findings must be clearly presented to patients in order to improve PCa screening acceptance.

Patient positioning during digital rectal examination of the prostate: preferences, tolerability, and results

“…Although some conditions such as obesity, hip patients that chose modified lithotomy position in current DRE were positioned in the same way in previous DRE examinations. In Furlan's study, if patients were able to choose a different position than supine, most patients would have preferred the standing-up position, followed by left lateral position (6). In the present study, patients undergoing DRE for the first time picked left lateral position first and standing-up position second.…”

“…Furlan et al reported that 53.9% of 269 patients preferred DRE in supine position (similar to modified lithotomy position) (6). A potential bias in this study was that patients answered the question regarding their preference after receiving DRE in supine position.…”

“…Positioning preference for examining the prostate varies from one country to another (4), from one examiner to another (5), and even from one patient to another (6). In the US, DRE is more often performed in the standing-up position, while in UK patients are usually examined in the lateral position (4).…”

“…Several positions have been recommended over the years to allow a thorough DRE, from the exaggerated knee-chest position and bimanual sitting-rectal position commonly used in the past (2,3), which are frequently uncomfortable, complicated and time-consuming, to the straightforward and most frequently used positions (lateral position, modified lithotomy position, and standing-up position) (4)(5)(6).…”

“…Although positioning preferences are individual and, there is little published information comparing different position techniques during prostate cancer screening (4)(5)(6). The purpose of this study is to evaluate the preferred position used by Brazilian Urologists to perform DRE, in which position Brazilian patients prefer or perceived as less embarrassing to undergo DRE.…”