'My finger is too short': Why some doctors don't do prostate exams

Fewer than one in seven doctors examines the prostate gland for cancer‚ with excuses including: “My finger is too short.”

Other reasons for not performing a digital rectal examination include‚ “it may pass as sexual harassment” and “there’s no privacy in the ward” and “lubrication is not available”.

Kalli Spencer‚ a urologist in the medical school at Wits University‚ questioned 303 doctors — excluding urologists — to assess whether they test for prostate cancer‚ and if not why not.

Writing in the South African Medical Journal‚ Spencer said the performance of digital exams and blood tests was “very low‚ which may have significant clinical implications”.

Prostate cancer is the most common solid organ cancer among men‚ according to the South African National Cancer Registry‚ with blacks at higher risk. Said Spencer: “The incidence increases at about 3% a year‚ with one out of 26 men developing prostate cancer in their lifetime and five men dying every day.”

Screening with an examination and a prostate-specific antigen blood test were important for early detection‚ but doctors at three Wits academic hospitals — Charlotte Maxeke‚ Helen Joseph and Chris Hani Baragwanath — were not keen on feeling the prostate via a man’s rectum.

One said: “I feel quite strongly that ... it is an intrusive waste of time carrying out rectal examinations.”

But Spencer said 18% of cancer cases were detected by a doctor’s finger‚ and digital rectal examination (DRE) was up to 68% effective in men without symptoms of cancer.

“General practitioners or other non-urologists should always perform DREs as part of their examination for the early detection of cancer‚” he said.

Four of the reasons doctors gave for not doing examinations were more prevalent among women: no privacy‚ cultural or religious convictions‚ anticipated patient refusal. and concern about the patient’s modesty.

Said Spencer: “The underperformance of the digital rectal examination not only leads to non-detection of some prostate cancer cases‚ but also deprives junior doctors of training. Teaching the physical examination on real patients remains an important part of medical education.”