ArticleCanadian Urological Association journal = Journal de l'Association des urologues du Canada2025
Does the digital rectal exam still provide value in the age of MRI?
Article in Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Integrating MRI-based tumour staging within the TNM classification system in modern prostate cancer management.Insights into imaging · 2026Review
- Performance of MRI-Based vs Clinical T Staging in Localized Prostate Cancer.JAMA network open · 2026Article
- Temporal trends in diagnostic work-up, treatment, and mortality in locally advanced prostate cancer in 2016-2024: nationwide, population-based study in Sweden.Acta oncologica (Stockholm, Sweden) · 2026Article
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAccurate staging of prostate cancer is essential for treatment planning and prognosis. While digital rectal exam (DRE) has traditionally been used, its limitations in detecting extracapsular extension (ECE) have led to increased reliance on multiparametric magnetic resonance imaging (mpMRI).
methodsThis study compared outcomes between T3 prostate cancer diagnosed by DRE vs. mpMRI only (i.e., not T3 by DRE) using data from the Alberta Prostate Cancer Research Initiative. The cohort included all 536 patients with cT3NxMx prostate cancer diagnosed between July 2014 and July 2024. The primary outcome was overall survival, with secondary outcomes including age at diagnosis, prostate-specific antigen (PSA) at diagnosis, treatment modality, Gleason grade group, and metastasis at diagnosis.
resultsPatients diagnosed as T3 by DRE were significantly older (71.6 vs. 67.9, p<0.001), had higher PSA levels (32% vs. 11% PSA >20 ng/ml, p<0.001), and higher Gleason grade groups (39% vs. 15% GG4+, p<0.001) compared to those diagnosed by mpMRI. DRE-diagnosed patients underwent radiation therapy and primary androgen deprivation therapy more frequently than MRI-diagnosed patients. DRE-diagnosed patients also had higher rates of metastases at diagnosis (16% vs. 5%, p<0.001) and worse overall survival (hazard ratio 4.6, 95% confidence interval 1.4-15.0, p=0.002).
conclusionsT3 prostate cancer diagnosed by DRE is associated with more advanced disease, higher metastasis rates, and worse survival compared to mpMRI-diagnosed T3 disease. These findings suggest that T3 disease identified by DRE represents a more aggressive cancer subtype and should be considered higher-risk in clinical decision-making.
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Registered trials
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