A Patient’s Relief: Why the “Finger Up the Bum” Is No Longer Needed for Prostate Checks
Ashwin Narasimha Sridhar
Consultant Urologist | Specializing in cancer diagnosis and management | Robotic surgery expert and Trainer | NHS and Private | Top 10 global Indian surgeon 2025
Recently, a patient came to my clinic visibly anxious. He’d heard horror stories about the digital rectal examination (DRE) and was dreading the idea of a “finger up the bum” to check for prostate cancer. His worry was so intense that it had delayed his visit to the GP for months. He was relieved to learn that, thanks to advances in prostate cancer diagnosis, he could avoid the DRE altogether—and still be sure he was getting the best care possible.
Why the DRE Is Becoming a Thing of the Past
For years, the DRE was a mainstay of prostate cancer screening. But as my patient discovered, times have changed. The British Association of Urological Surgeons (BAUS) and Prostate Cancer UK now agree: the DRE is a poor test for detecting prostate cancer and should no longer be routine[1][2][5]. In fact, around a third of men who ask their GP for a PSA blood test are still offered a DRE—sometimes even instead of a PSA test—despite clear evidence that this isn’t the best approach[1].
The reason is simple: a clinician performing a DRE can only feel the back wall of the prostate. Most prostate cancers, however, develop in the front or middle of the gland—areas the DRE simply can’t reach[1][2][5]. This means many early cancers are missed, and men may be falsely reassured or, worse, put off seeking help altogether because of the discomfort or stigma associated with the procedure.
A Better Path: PSA Blood Test and MRI
Today, the first step in checking for prostate cancer should be a simple blood test to measure prostate-specific antigen (PSA)[1][3][7]. If the PSA is raised, the next step is an MRI scan of the prostate—not a DRE[1][2][4]. MRI technology has revolutionised prostate cancer diagnosis, providing detailed images that allow doctors to see the entire gland, not just the back wall[2][4]. This means cancers that would have been missed by a DRE can be detected early, when treatment is most effective.
MRI scans are not only more accurate but also reduce the number of unnecessary biopsies. They help doctors distinguish between harmless changes and potentially aggressive cancers, guiding targeted biopsies only when needed[4]. This approach is safer, more comfortable for patients, and leads to better outcomes.
Evidence and Guidelines Support This Change
Recent studies and updated NHS guidelines confirm that the DRE should no longer be routine for prostate cancer screening[1][2][5]. The National Institute for Health and Care Excellence (NICE) now recommends that men with suspected prostate cancer should have an MRI scan as the first investigation after a raised PSA, not a DRE[2][4]. This change is based on robust evidence showing that MRI is far superior at detecting clinically significant prostate cancer and reducing unnecessary procedures.
Breaking Down Barriers to Early Diagnosis
One of the biggest barriers to early prostate cancer diagnosis is the fear and embarrassment associated with the DRE[1][5]. This is especially true for Black men, who are at double the risk of prostate cancer and often face greater stigma around the procedure[1]. By moving away from the DRE and towards a blood test and MRI, we can make testing more accessible and less intimidating for all men.
A Personal Message to Men
If you’re worried about prostate cancer, know this: you don’t need a “finger up the bum” to get checked. Start with a conversation with your GP and a simple blood test. If your PSA is raised, you’ll be referred for an MRI—a safer, more accurate, and far less invasive way to get peace of mind[1][2][4].
As my patient learned, the days of dreading the DRE are over. With modern medicine, you can get the answers you need without unnecessary discomfort or anxiety. That’s progress we can all be grateful for.
Citations:
[2] Is the digital rectal exam any good as a prostate cancer screening ... https://pmc.ncbi.nlm.nih.gov/articles/PMC10904122/
[3] Screening Tests for Prostate Cancer https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/tests.html
[4] The Growing Importance of MRI in Prostate Cancer Screening https://www.darcyhealthcare.co.uk/post/the-indispensable-eye-the-growing-importance-of-mri-in-prostate-cancer-screening
[5] Rectal examinations aren't good at catching prostate cancer early ... https://prostatecanceruk.org/about-us/news-and-views/2023/03/dre-aren-t-good-at-catching-prostate-cancer-early/
[6] Digital Rectal Examination Is Not a Useful Screening Test ... - PubMed https://pubmed.ncbi.nlm.nih.gov/37806841/
[7] What is the PSA test? | Cancer Research UK https://www.cancerresearchuk.org/about-cancer/tests-and-scans/prostate-specific-antigen-psa-test
[8] You don't need a 'finger up the bum' to diagnose prostate cancer https://prostatecanceruk.org/about-us/news-and-views/2024/06/barriers-to-diagnosis/
[9] Digital Rectal Examination Is Not a Useful Screening Test for ... https://www.sciencedirect.com/science/article/abs/pii/S2588931123002031
[10] Is the digital rectal exam any good as a prostate cancer screening ... https://bjgp.org/content/digital-rectal-exam-any-good-prostate-cancer-screening-test
[11] Evaluation of the Digital Rectal Examination as a Screening Test for ... https://academic.oup.com/jnci/article-abstract/90/23/1817/2520677
Improvement Leader | Disability Inclusion Ally | NHS Administrator | #NSPPDian
2mo👏🏽 Dr. Chinonso Fidelis Egemba did a lovely Youtube video on his page @AprokoDoctor and Caribbean & African Health Network (CAHN) had their weekly Saturday morning Health Hour on the subject. I hope this news and more awareness helps get men to go to their GPs 🙏🏽