Digital rectal examination and carcinoma of the prostate.

Urologists have considered themselves to be the experts in the use of digital rectal examination for the evaluation of diseases of the prostate. However, without close attention to the teaching of this examination, it probably is inaccurate and unreliable. Moreover, many patients who are destined to die of prostate cancer never develop a palpable abnormality. In patients with prostate cancer, a palpable abnormality usually indicates the presence of carcinoma, but the majority of patients will be upstaged by pathologic examination. In patients undergoing a digitally guided biopsy, it appears critical that those with a negative biopsy be followed closely, as they have a measurable risk of developing overt carcinoma. It is unclear how transrectal ultrasound will interface with digital rectal examination because of the multiple echo patterns this disease can exhibit.