Rectal Exam a “Poor Test for Prostate Cancer” — Surgeons and Charity Agree
09 June 2025
(Last updated: 9 Jun 2025 08:30)
- The British Association of Urological Surgeons aligns with Prostate Cancer UK in declaring that men do not need a 'finger up the bum’ to test for prostate cancer.
- Despite this, new data shows a third of men surveyed were still being offered a rectal exam – sometimes instead of a PSA blood test.
- In a joint statement, surgeons and charity say to men: “understand your risk of prostate cancer by doing Prostate Cancer UK’s online risk checker, and if you decide to talk to your GP about testing, know that you can ask to have just a blood test.”
- Prostate cancer is now England’s most common cancer – and the only common cancer without a screening programme.
We, along with leading men’s health charity Prostate Cancer UK, have united in calling for an end to the routine use of the digital rectal examination (DRE), stating that it is no longer a useful test for prostate cancer.
We have announced today (9 June 2025) that we will work with NHS England and other stakeholders in advising GPs that men with suspected prostate cancer do not need a rectal exam before being referred for further tests.
We are responsible for promoting the highest standards of practice in urology, including the diagnosis of prostate cancer.
The efficacy and necessity of the rectal exam has been widely called into question in recent years.
In 2024, a group of experts from across the prostate cancer field — comprising researchers, clinicians, patients, and Prostate Cancer UK representatives — formed a landmark consensus that the DRE is not a useful test for finding prostate cancer.
This conclusion was also backed up by the latest medical guidelines in the Getting it Right First Time (GIRFT) prostate cancer programme, produced by the NHS.
Despite the DRE’s poor ability to detect cancer, new data shows it's still being offered to men. In a recent survey of men who had completed Prostate Cancer UK’s Risk Checker, around 750 men said they’d asked their GP for a PSA blood test. A third of these men were offered a rectal examination as well as a PSA blood test. Alarmingly, 3% of men were offered a rectal exam instead of a PSA blood test.
Although the DRE was historically considered a standard test, the information a GP can get from a rectal exam is of extremely limited value. The DRE only enables the clinician to feel the back wall of a man’s prostate, and most prostate cancer develops on the front wall of the gland, where it cannot be felt — so can easily be missed by this outdated test.
That cancer would, however, be picked up by a detailed MRI scan. Thankfully, since the introduction of MRI and modern targeted biopsies as standard in the NHS since 2019, the diagnostic process is more accurate than it’s ever been.
It’s also never been safer: research led by Prostate Cancer UK shows that the way prostate cancer is diagnosed — with a PSA blood test followed by an MRI scan — reduces potential harms to men by 79%.
In a joint statement, BAUS and Prostate Cancer UK said: “The digital rectal exam is a poor test for prostate cancer. The way that prostate cancer is diagnosed has improved vastly in recent years with the introduction of MRI scans and new biopsy techniques.
“A clinician using their finger to feel the prostate is a legacy of the historic pathway; it does not add clinical value but can be a major deterrent to men coming forward for checks. In a cash-strapped, time-poor NHS, it makes no sense to do a test unless it could change clinical decision making.
“Our message to men is: understand your risk of prostate cancer by doing Prostate Cancer UK’s online risk checker, and if you decide to talk to your GP about testing, know that you can ask to have just a blood test. You don’t need a finger up the bum to test for prostate cancer.
“Our message to GPs is: if a man has a raised PSA result there is no need to do a physical exam – refer him for an MRI which will far more accurately identify whether or not he has cancer.
“Our message to our urology colleagues is: check your referral criteria and make sure that a rectal examination is not required for referral if the PSA level is raised.”
The infamous ‘finger’ test has long been a part of conversations about prostate cancer, and popular culture is full of jokes about it, which has built a massive stigma around it.
Because of this, not only is it ineffective at finding prostate cancer, it’s also deterring men from speaking to their GP about prostate cancer risk and testing – condemning many to get a late, incurable diagnosis.
Evidence shows that fear of rectal exams is the greatest barrier to men taking action by talking to their GP about the PSA blood test. Different research from Prostate Cancer UK found that in a group of more than 2,000 men, 60% were concerned about having a rectal exam. Of those, 37% would not speak to a GP about prostate worries because they feared the DRE.
Even worse, Black men — who have twice the risk of getting prostate cancer and dying from it — report that they feel an even greater stigma about rectal exams.
Vishwanath Hanchanale, Chair of Section of Oncology at BAUS said: “Digital rectal examination, or DRE, has long been a part of how we assess prostate health, but the truth is, with modern tools like PSA blood tests and MRI scans offering far more accurate insight, the DRE is increasingly redundant in prostate cancer diagnosis.
“In practice, many men referred with abnormal DREs are found to have normal results when assessed by urology specialists.
“Emerging evidence confirms that DRE is a poor test, with limited role in both diagnosing and active surveillance of prostate cancer. Yet, its continued presence in referral guidelines is causing confusion and anxiety - putting men off seeking help, and ultimately delaying life-saving diagnoses.
“It’s important that NHS pathways continue to evolve in line with the latest evidence, ensuring men receive the most accurate and effective care. By focusing on modern, evidence-based approaches, we can reduce unnecessary anxiety and encourage more men to come forward for assessment.
“If you’re concerned about prostate cancer, speak to your GP about a PSA blood test. It’s a simple and effective first step in understanding your risk.”
Amy Rylance, Assistant Director of Health Improvement at Prostate Cancer UK, said: “Even though experts agree it’s a poor test that should now be consigned to history, the spectre of the rectal exam is still making men think twice about going to their GP.
“There is no screening programme for prostate cancer, but most men don’t get any symptoms in the early stages, when it’s easier to cure. Men need to understand their risk and ask for a test – but when you feel healthy and the prospect of “the finger” makes you anxious to visit the GP, it’s easy to put it off. This is causing more men to get an incurable prostate cancer diagnosis, and deepening health inequities in the UK amongst men at the highest risk of getting prostate cancer.
“Over two years ago, Prostate Cancer UK submitted evidence to the National Screening Committee in favour of targeted screening for men at the highest risk of getting the disease. In the meantime, we’re calling on the Government to change outdated NHS guidelines so that GPs can finally be empowered to start conversations with men at the highest risk about PSA testing. This could save hundreds of lives every year.
“If you’re a man reading this, just remember you don’t need a finger up the bum to test for prostate cancer. It’s a simple blood test. Find out your risk in 30 seconds on Prostate Cancer UK’s online Risk Checker.”
The charity has also launched its £42m TRANSFORM trial, the biggest prostate cancer screening trial in a generation. TRANSFORM will compare the most promising tests and provide definitive evidence about the best way to screen for prostate cancer. The rectal exam will not be part of TRANSFORM, further confirming the test must be left in the past.
We, alongside Prostate Cancer UK, have developed responses to a number of Frequently Asked Questions which you may have following this announcement - please see below.
Read our DRE FAQ's here
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