Digital rectal exam following prostatectomy: Is it still necessary with the use of PSA?

Study objective: To establish the value of digital rectal exam with respect to PSA in the follow up of radical prostatectomy for prostate adenocarcinoma. Design: Retrospective analysis. Setting: Tertiary care center. Patients: The charts of 537 patients having undergone radical retropubic prostatectomy from April 1989 to November 2000 were reviewed. Interventions: The operations took place in one institution. Follow-up took place at 1 month, 3 months and 6 months and from then on every 6 months. When patients reached 36 months without relapse, follow-up was done on a yearly basis. DRE was performed on every follow-up visit until relapse occurred. Blood samples were collected on every follow-up visit for PSA measurements. Main outcome measures: Pathological grade and margin status. Digital rectal exam (DRE) on every visit. PSA levels for each visit. Bone scan and anastomotic biopsy results when done. Date and cause of death were recorded where applicable. Measurements and main results: Of 423 patients with inclusion criteria, 31 (7.3%) had at least one positive DRE on follow-up. All of these had at least one detectable PSA measurement before DRE became positive. Clinically local recurrence took place an average of 27 +/- 17 months following surgery (range 1-36 months) PSA was an average 14 +/- 11 months earlier in detecting relapse than DRE. Isolated PSA recurrence was noted in 98 (25.5%) patients. Conclusion: Given our results and those obtained by other authors, it is acceptable to omit DRE in the follow-up of radical retropubic prostatectomies until PSA becomes detectable. (C) 2003 Elsevier Science B.V. All rights reserved.