title: Is DRE essential for the follow up of prostate cancer patients? A prospective audit of 194 patients.
abstract: BACKGROUND
  Prostate cancer follow up forms a substantial part of the urology outpatient workload. Nurse led prostate cancer follow up clinics are becoming more common. Routine follow-up may involve performing DRE, which may require training.
  
  
  OBJECTIVE
  The aim of this audit was to assess the factors that influenced the change in the management of prostate cancer patients during follow up. This would allow us to pave the way towards a protocol driven follow up clinic led by nurse specialists without formal training in DRE.
  
  
  RESULTS
  194 prostate cancer patients were seen over a period of two months and all the patients had DRE performed on at least one occasion. The management was changed in 47 patients. The most common factor influencing this change was PSA trend. A change in DRE findings influenced advancement of the clinic visit in 2 patients.
  
  
  CONCLUSIONS
  PSA is the most common factor influencing change in the management of these patients. Nurse specialists can run prostate cancer follow-up clinics in parallel to existing consultant clinics and reserve DRE only for those patients who have a PSA change or have onset of new symptoms. However larger studies are required involving all the subgroups of patients to identify the subgroups of patients who will require DRE routinely.
authors.affiliation: Department of Urology, Lancashire Teaching Hospitals NHS Trust, Preston, Lancashire, United Kingdom. n.ragavan@lancaster.ac.uk
authors.forename: Narasimhan
authors.initials: N
authors.lastname: Ragavan
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Sangar
authors.forename: Sujoy
authors.initials: S
authors.lastname: Gupta
authors.forename: Jennifer
authors.initials: J
authors.lastname: Herdman
authors.forename: Shyam S
authors.initials: SS
authors.lastname: Matanhelia
authors.forename: Michael E
authors.initials: ME
authors.lastname: Watson
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Blades
mesh_terms: D000368:Aged; D051517:Digital Rectal Examination; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*