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Internal Medicine Clinic Research Consortium; Coleen M. Andruss, MD; Thomas J. Dinella, MD; David S. Macpherson, MD, MPH; Anthony P. Pietropaoli, MD; Lana Tsao, MD; Jill Wachman, MD; Jeff Whittle, MD, MPH; Coleen M. Andruss, MD; Mary L. Cameron, MD; Janet M. Hines, MD; David S. Macpherson, MD, MPH; Melissa McNeil, MD; Lana Tsao, MD; Jeff Whittle, MD, MPH; Joseph Conigliaro, MD, MPH; C. Bernie Good, MD, MPH; Steven E. Labkoff, MD; Colleen M. Andruss, MD; Mary L. Cameron, MD; Mitchell G. Cohen, MD; Anita Deswal, MD; Thomas Dinella, MD; Mark D. Gulinson, MD; Laurie M. Hankin, MD; Michael S. Heinle, MD; Carol J. Higham, MD; Janet M. Hines, MD; Erika L. Hoffman, MD; Richard H. Hunn, MD; Timothy M. Hunter, MD; Laurance W. Kam, MD; Robert J. Leon, MD; Steven Lilie, MD; Joseph L. Lipinski, MD; Lisa A. Marr, MD; Kevin J. McCullum, MD; Glenn C. Michelson, MD; David A. Nace, MD; Daniel J. O'Rourke, MD; Jennifer L. Osborn, MD; William J. Pendergast, MD; Mark A. Provensano, MD; Lisa C. Ramsey, MD; Lawrence C. Reardon, MD; Marc I. Sandberg, MD; John J. Szawaluk, MD; Lana Tsao, MD; Sander van Cleeff, MD; Michele A. Young, MD; Emily L. Yee, MD; Robert K. Zeldin, MD; Karl E. Bushman, MD; Anthony P. Pietropaoli, MD; David S. Richards, MD; Jill, MD; Virginia Balderston, MD; Karen E. Caldwell, MD; Mark E. Collins, MD; Edward G. Dianesi, MD; Caroline G. Dale, MD; Julia M. Dippl, MD; Michael W. Finikiotis, MD; Robert G. Finkel, MD; David M. Friedland, MD; Robert S. Gorby, MD; Ruth Ann Guilinger, MD; Robert J. Hally, MD; Samuel I. Hammerman, MD; James V. Harris, MD; Kathleen J. Keyes, MD; Steven E. Labkoff, MD; Rosemarie A. Leuzzi, MD; Caroline J. Lubick, MD; Michael A. McGuiness, MD; Donna C. Needleman, MD; Robert J. Pritchard, MD; Mariellen T. Rodman, MD; Stephen G. Rohn, MD; Dawn M. Santora, MD; Edward J. Schloss, MD; Thomas A. Selvaggi, MD; Todd D. Shuster, MD; Alan R. Stein, MD; Leighton J. Sweet, MD; Steven T. Tee, MD; Abraham Thomas, MD; Richard C. Hogan, MD; Erol M. Kosar, MD; Thomas I. Murtaugh, MD; Joseph Conigliaro, MD, MPH; C. Bernie Good, MD, MPH; Jennifer Hartle, MPH; Richard P. Lofgren, MD, MPH; David S. Macpherson, MD; MPH; Melissa McNeil, MD; Jeff Whittle, MD, MPH

Arch Intern Med. 1995;155(4):389-392.

Abstract
Background
Measurement of serum prostate-specific antigen (PSA) and digital rectal examination (DRE) are commonly used for prostate cancer screening. Clinicians have been advised to avoid measuring serum PSA after DRE because of the possibility of spurious elevation. However, studies in healthy volunteers have found no change. We sought to determine whether DRE performed by internists affects PSA levels in a primary care clinic population.

Methods
Men older than 49 years enrolled in a Veterans Affairs internal medicine clinic were eligible for the study. For all patients, prostate size and nodularity were assessed by DRE. Blood for determination of PSA levels was drawn immediately before DRE and 30 minutes after DRE. All patients completed a questionnaire regarding voiding.

Results
Two hundred two men aged 50 to 85 years (mean, 67 years) were enrolled and had complete data. The mean PSA level increased by 0.26 µg/L after DRE (P<.001). Six patients (2.9%; 95% confidence interval, 0.6% to 5.3%) had an increase in PSA level from less than 4 µg/L to more than 4 µg/L after DRE. There was a statistically significant but weak correlation between voiding score and PSA level (coefficient.17; P=.02). Patients with an enlarged prostate gland had higher PSA levels than did patients with normal prostates or borderline results of examination. Nodularity did not predict an increased PSA level.

Conclusions
We conclude, in an elderly veteran population, that DRE causes a statistically significant but clinically insignificant increase in serum PSA level. Additionally, we found that symptoms and physical examination results cannot be used to select a population for whom PSA screening would likely be useful.

(Arch Intern Med. 1995;155:389-392)

Author Affiliations
Protocol Development Committee; Data Entry and Analysis Committee; Participating House staff

Footnotes
Participating members of the Internal Medicine Clinic Research Consortium are listed on page 392.

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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

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Arch Intern Med 1996;156:1352-1352.
ABSTRACT  

DOES RECTAL EXAM INCREASE PSA LEVELS?
JWatch General 1995;1995:6-6.
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