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A finger or not

- Wits University

Fewer than 1 in 7 doctors examine the prostate gland for cancer, a new study finds.

The study by Dr Kalli Spencer, urologist from the Wits Medical School, found that doctors with less than seven years’ experience are less likely to test male patients for prostate cancer by conducting a digital rectal examination or DRE.

The study, titled: A finger or not? Prostate examinations by non-urologists at a South African academic institution, was published on 30 June 2017 in the South African Medical Journal.

Spencer questioned 303 doctors, excluding urologists, from three Wits academic hospitals — Charlotte Maxeke‚ Helen Joseph and Chris Hani Baragwanath – to assess whether they test patients for prostate cancer, and if not, why not?

Some of the reasons given for not performing a DRE include the doctors saying their 'fingers are too short’; ‘the examination may pass as sexual harassment’; ‘there is no privacy in the emergency department or admission ward’; or that they 'forgot'.

Spencer found fewer than 1 in 7 doctors examine the prostate gland for cancer using the DRE. This is alarming as the DRE adds to the sensitivity and specificity of serum prostate-specific antigen (PSA) testing and is an important component of the assessment for the early detection of prostate cancer.

Where breast cancer is the most common cancer presenting in South African women across the board, prostate cancer is the most commonly diagnosed solid-organ cancer in South African men, according to the According to the South African (SA) National Cancer Registry: with 1 in 26 men developing prostate cancer in their lifetime, five men dying every day, and black men being at higher risk.

TimesLIVE reports Spencer said 18% of cancer cases were detected by a doctor’s finger‚ and digital rectal examination (DRE) was up to 68% effective in men without symptoms of cancer.

Performance rates of DRE and PSA testing by doctors who are not urologists are very low, which may have significant clinical implications. It is recommended that SA prostate cancer screening guidelines are necessary to change practice with regard to this condition.

Still, many men shy away from this type of prostate screening. The Azania Mosaka Show on 702/CapeTalk shared Spencer’s findings and asked listeners to phone in and share their experiences or reluctance for testing for prostate cancer.