title: Reasons why patients reject digital rectal examination when screening for prostate cancer.
abstract: OBJECTIVE
  To evaluate the reasons why patients reject digital rectal examination (DRE) when screening for prostate cancer.
  
  
  METHODS
  Four hundred and fifty men were prospectively evaluated in a prostate cancer educational program consisting of lectures, PSA testing, and DRE. Patients rejecting DRE were compared with those accepting DRE in regard to epidemic, social and cultural variables.
  
  
  RESULTS
  DRE was rejected by 8.2% of patients. Refusal rate was not different when patients were stratified by age, prostate cancer family history, school level, family income, and PSA level. Patients with a prior history of DRE had a lower rejection rate than those undergoing DRE for the first time (4.4% vs. 10.4%, p = 0.038). Patients with mild or no lower urinary tract symptoms rejected DRE more frequently than those with moderate or severe symptoms (9.6% vs. 1.4%, p = 0.018). Misconceptions about prostate cancer screening were present in 84.4% of those rejecting DRE vs. 46.9% of controls (p = 0.002); 43.7% expected severe discomfort in the group that rejected DRE vs. 28. 1% in the control group (p = 0.090); fear of finding a cancer during DRE was present in 34.4% of patients that refused DRE vs. 46.9% of controls (p = 0. 121); and 53.1% of patients rejecting DRE responded it was a source of shame vs. 15.6% of patients in the control group (p = 0.019).
  
  
  CONCLUSIONS
  The main reasons patients reject DRE when attending prostate cancer screening are the lack of lower urinary tract symptoms, misconceptions about prostate cancer screening and shame, especially when undergoing screening for the first time.
authors.affiliation: Instituto Curitiba de Saúde (ICS), Curitiba, PR, Brazil. frederico.romero@gmail.com
authors.forename: Frederico R
authors.initials: FR
authors.lastname: Romero
authors.forename: Karen Richter P Santos
authors.initials: KR
authors.lastname: Romero
authors.forename: Filho Thadeu
authors.initials: FT
authors.lastname: Brenny
authors.forename: Roberto
authors.initials: R
authors.lastname: Pilati
authors.forename: David
authors.initials: D
authors.lastname: Kulysz
authors.forename: Fernando César
authors.initials: FC
authors.lastname: de Oliveira Júnior
mesh_terms: D000328:Adult; D000368:Aged; D051517:Digital Rectal Examination; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D016312:Treatment Refusal