There are patients for whom the rectal exam makes sense, Salner said, such as those who have urinary tract symptoms.
A Complementary Test
Not everyone agrees.
The American Urological Association recommends that men who wish to be screened for prostate cancer receive both the PSA test and the digital rectal exam.
And Dr. Jeffrey Steinberg, chairman of surgery at St. Francis and medical director of the Curtis D. Robinson Men's Health Institute, said the digital rectal exam has value that should not be discounted.
A patient could have a PSA test in the normal range, but a digital rectal exam could turn up a nodule that might indicate cancer, he said. The PSA is not a perfect test, Steinberg said, and the digital rectal exam offers a complement to it. It also helps doctors detect other conditions, like a benign enlarged prostate.
"The rectal exam is a valuable adjunct when we're seeing patients either for initial testing or if they're referred to a specialist," he said.
Still, Steinberg knows the test is not a crowd pleaser.
The newly launched men's health institute offered screenings last weekend at The First Cathedral in Bloomfield. Some men there wanted just the blood test, without the rectal exam.
When that happens, Steinberg said, men should be told about the importance of the rectal exam and that the PSA is only half of the recommended test.
"You have to respect patient's fears and you have to give them reassurances that literally the digital rectal examination lasts five seconds," Steinberg said. When he administers it, he has men count to five, to prove that, contrary to what they may think, it only takes a few seconds.
"It's five seconds of discomfort for an exam that could potentially detect cancer or other abnormalities," he said.
At The First Cathedral, about 150 people came, and the majority took advantage of the PSA testing and the rectal exam.
But for those who won't agree to the digital rectal exam, Steinberg still administers the blood test. It's not all or nothing, he said.
"If they still refuse and they know the possibility that you're missing significant pathology, if they're willing to have the PSA test, at least you're having some testing with that man," Steinberg said.