Digital Rectal Examination of Prostrate : Does Examiner's Experience influence the Results ?

There is lack of uniformity in grading the size or assessing the consistency of prostate gland with Digital Rectal Examination (DRE) when done by different clinicians during evaluation of prostate pathology. This study was to compare the results of DRE findings in prostate pathology performed by Urologists at three different levels of clinical practice in the same set of patients and assess the accuracy of the findings with respect to their clinical experience. Materials and Methods: 200 patients with clinical features of prostatomegaly having no documented Urinary Tract Infection were subjected to DRE separately by one Resident in his Final year of training, Junior Consultant (5 years post degree) and Senior Consultant with more than 10 years clinical experience. Their findings were correlated with USG Abdomen estimated volume. Patients with DRE detected hard area in the prostate underwent Trans-rectal tru-cut biopsy of the hard area in the prostate and the biopsy reports were again correlated with the clinical findings. Results: DRE grades assessed by Final year Resident correlated with USG Abdomen estimated volume in 63%, while the same for Junior Consultant was 69% and that for Senior Consultant was 71%. The percentage correlation was better with smaller clinical size of the prostate when the overall DRE assessment of the prostate volume by the three sets of observers was compared to USG Abdomen prostate volume. There was also error in diagnosing abnormal texture of the prostate by Final year Resident in a significant number of patients. Conclusions: There were significant variations in DRE findings of prostate among clinicians, with the accuracy improving with increase in clinician’s experience. DRE findings should always be supplemented with other investigations before a final conclusion regarding the prostate pathology is made.