Routine use of MRI scans during active surveillance of men with prostate cancer allows patients to skip digital rectal examinations and some biopsies and this approach is best practise.
Some doctors do the digital rectal exam even though the patient is getting the MRI but a panel of experts agree that DRE is not needed if you are getting the MRI.
Limitations of the MRI is the cost and that insurance coverage can vary widely.
When PSA levels and MRI are stable , physicians may be able to avoid performing further prostate biopsies.
PSA levels should be monitored every 3- 6 months whereas the timing of MRI may be more open ended.
But the DRE wont disappear completely as they are used not only for the occasional prostate abnormality on palpating but also for the detection of rectal lesions. Also they can be used to investigate a wide range of rectal and anal cancers, constipation ,heamorroids and inflammatory bowel disease, says Leonard Marks , MD, a urologist at University of California.
Physical discomfort can be a concern and one group found that 60 % of patients reported at least moderate discomfort during the exam and 20 % had urinary or bowel urgency. The degree of discomfort did not affect the patients intention to have another exam in the future.
