Digital Rectal Exams Are Still Being Used Despite Better Technology

Reported in The Times this morning, thousands of men in the UK could be living with undiagnosed prostate cancer because GPs are still relying on outdated diagnostic methods. Leading urology experts have warned that current NHS guidelines have failed to keep pace with modern medical technology, and the consequences could be fatal, certainly late prostate cancer diagnosis are likely to have worse outcomes for patients.

The British Association of Urological Surgeons, together with Prostate Cancer UK, has called for an urgent review of the national approach to prostate cancer detection. The core of their concern is that general practitioners are still being advised to use the digital rectal examination, often referred to as the “finger test”, as part of the standard assessment, even though this method is now widely considered to be ineffective.

Why the Finger Test Is No Longer Fit for Purpose

The digital rectal exam involves a GP manually feeling the prostate through the rectum to detect abnormalities. While once considered a basic screening tool, advances in medical imaging have shown that many prostate tumours cannot be felt manually, especially those located at the front of the gland. Relying on this outdated test may give patients false reassurance or lead to delayed diagnosis when the cancer has already progressed.

Mr Vishwanath Hanchanale, Clinical Director for Urology at Royal Liverpool University Hospital and cancer lead for the British Association of Urological Surgeons, has stated:

“The DRE does not have any role at all in the diagnosis of prostate cancer. If someone has a PSA test and it is high, they do not need a DRE. They can be referred for a scan.”

Yet GPs continue to follow guidance last updated in 2016, which still recommends the DRE alongside the PSA (prostate-specific antigen) blood test. This guidance remains unchanged despite MRI scanning and targeted biopsies now offering significantly more accurate early detection.

Men Are Being Put Off Getting Tested

The outdated reliance on DREs is more than just poor clinical practice. It is actively deterring men from seeking help. Surveys show that up to 30 percent of men delay or avoid seeing their GP because of fear or embarrassment over rectal examinations.

Amy Rylance, assistant director at Prostate Cancer UK, said:

“The spectre of the rectal exam is still making men think twice about going to their GP. Most men do not get any symptoms in the early stages, when it is easier to cure.”

Indeed, prostate cancer is often symptomless in its early stages. Men may feel perfectly healthy even while the disease is silently progressing, which makes early screening all the more vital.

Missed Diagnoses Due to Outdated GP Decisions

Perhaps most concerning are the stories of men being refused PSA tests, even those in higher-risk groups. One such case is that of Patrick Nyarumbu, a 46-year-old NHS deputy chief executive in Birmingham. Despite a family history of prostate cancer and a clear understanding of his own risk profile, his GP declined to provide a PSA test and instead offered a DRE. Only through a separate research programme at the Royal Marsden Hospital was he able to access the PSA test he had initially requested.

This highlights the real barriers many men face when trying to access potentially life-saving tests. If medical professionals fail to follow updated practices or actively deny access to appropriate screening, the consequences can be life changing or even fatal.

A Modern Approach to Diagnosis Is Urgently Needed

Experts and campaigners are now pushing for reform. Prostate Cancer UK is urging GPs to be more proactive in offering PSA testing to men in at-risk groups, including Black men and those with a family history of prostate cancer.

The charity is also calling for routine follow-up with MRI scans where PSA levels are elevated, replacing the unnecessary and often misleading DRE. These combined diagnostic tools offer a far more accurate assessment and could help catch prostate cancer in time for curative treatment.

Calls are also growing for a national screening programme similar to those for breast and bowel cancer. The UK National Screening Committee is reviewing the evidence and is expected to provide updated recommendations later in 2025.

A Delayed Diagnosis Can Have Serious Consequences

More than 12,000 men die from prostate cancer every year in the UK. Many of these deaths could be prevented through earlier detection and treatment. Delays caused by outdated tests or poor clinical judgement can mean the difference between a localised, treatable cancer and a late-stage, incurable condition.

Patients who suffer harm as a result of delayed diagnosis may be entitled to make a claim for clinical negligence. This includes cases where:

• A GP refused or failed to offer a PSA test despite known risk factors
• The DRE was relied on as the main diagnostic tool
• Referrals for scans or further investigation were delayed
• Symptoms were dismissed without appropriate follow-up

These are not just clinical oversights. They are missed opportunities that can shorten lives and devastate families.

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You May Be Entitled to Make a Claim

The use of outdated diagnosis or just poor judgement on behalf of health professionals  could be fatal, certainly late prostate cancer diagnosis are likely to have worse outcomes for patients. If you or a loved one has experienced a delay in the diagnosis of prostate cancer and believe outdated advice or poor decision-making was to blame, you may be entitled to make a claim for medical negligence.

We are currently supporting individuals and families affected by late cancer diagnoses and are committed to securing answers and justice.

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