Prostate Cancer Patients' Perceptions Regarding the Relevance of a Digital Rectal Examination During Their Follow-Up After Radiation Therapy

Background: Prostate cancer is an example of the undervaluation of clinical examinations in care of patients. After external radiotherapy, cancer recurrence is primarily determined biologically by measuring prostate-specific antigen concentration. Consequently, there is no systematic requirement for the digital rectal examination (DRE). Nevertheless, research has shown that patients attach both practical and symbolic significance to being examined by their physicians. This study aimed to assess how patients perceive DRE omission after prostate cancer radiation therapy.

Materials and methods: We conducted a survey of 107 men in remission after radiotherapy for prostate cancer in the Radiotherapy Oncology Department of Bordeaux University Hospital, France. The aim of the survey was to assess the significance that patients place on undergoing a DRE as part of their follow-up care, both from a practical perspective (medical relevance) and a symbolic perspective (influence on the perception of the treating radiation oncologist).

Results: Despite receiving information on the lack of relevance of DRE during follow-up, 40 of the 100 respondents still perceived a practical benefit of undergoing DRE (pragmatic dimension). On a symbolic level, many patients associated the performance of DRE by their radiotherapy oncologist with impressions of competence, concern for their health and concern for them personally (61%, 63% and 64%, respectively). Although the correlations between the pragmatic and symbolic dimensions were significant, more than one-third of patients who understood the lack of clinical relevance of DRE still attributed symbolic value to it.

Conclusions: A positive perception of DRE persists among patients, mainly at the symbolic level, including a proportion of patients who understand the low clinical utility of DRE. Importantly, the persistence of these perceptions regarding DRE should not be misconstrued as justification for performing pelvic examinations without clear clinical reasons.