DRE
Meaning of DRE: Digital here means finger rather than electronic, and the reach of that finger is the main limitation of the whole examination.
Definition of DRE
DRE stands for digital rectal examination, a physical examination in which a clinician places a gloved, lubricated finger into the rectum to feel the structures around it. In males it allows the back surface of the prostate gland to be assessed for size, firmness, lumps or uneven shape. It also detects masses, tenderness and bleeding within the rectum itself.
What can the examiner actually feel?
The prostate sits directly in front of the rectum, so only a thin wall separates it from the examining finger. A normal gland feels smooth and rubbery, roughly the size of a walnut, with a shallow groove running down the middle. Departures from that carry meaning. A hard nodule, a gland that feels firm rather than springy, loss of the groove or one side larger than the other all prompt further evaluation. A gland enlarged evenly and still smooth suggests the benign growth that is near universal with age. Warmth and marked tenderness suggest inflammation. Beyond the prostate, the same examination assesses the tone of the anal muscle, finds hemorrhoids and low rectal masses, detects hardened stool filling the rectum, and shows blood on the withdrawn glove.
What are its limits?
| Within reach | Out of reach |
|---|---|
| The back surface and part of the sides of the prostate | The front of the gland and its upper portion |
| The lowest stretch of the rectum | Everything higher in the bowel |
| Firm or irregular texture near the surface | Small tumors and those set deep within the gland |
Two consequences follow. A normal examination does not rule out prostate cancer, because a substantial share of tumors arise where a finger cannot reach. And an abnormal one does not establish it, since stones, scarring, past inflammation and benign nodules all feel firm. Findings also vary between examiners more than most people expect.
How does it sit alongside the blood test?
The two look at different things. A prostate specific antigen test measures a protein released into the blood by prostate tissue, healthy or otherwise, while the examination assesses texture and shape directly. For years the pair were performed together for screening, but reviews of the evidence have found little sign that adding a rectal examination to the blood test finds cancers that would otherwise be missed, and several guideline groups no longer include it as a routine screening step in men without symptoms. It remains in regular use elsewhere: in working up urinary or rectal symptoms, in assessing an already diagnosed cancer, and as part of a general physical examination. Neither result settles anything on its own, since a diagnosis of cancer requires tissue.
Also known as
Used in a sentence
A digital rectal examination was performed as part of the routine physical exam.
Good to know
A digital rectal examination assesses the prostate directly by touch, while a prostate-specific antigen blood test measures a separate laboratory marker, and neither result alone is diagnostic of cancer.
Word origin
Where “DRE” comes from
Digital comes from Latin digitus, meaning finger, and rectal from Latin rectum, meaning straight, the name given to the final straight section of the bowel.