A Jamaican urologist is urging a shift in the focus of prostate cancer screening from the long-promoted digital rectal examination (DRE) to the prostate-specific antigen (PSA) blood test, citing what she says is the low sensitivity of the DRE in early detection of the disease.

“We are trying to put more emphasis on men doing their prostate-specific antigen blood test, also known as the PSA blood test, rather than the rectal examination or DRE,” Dr Colette Antoine told the Jamaica Observer.

“If you have an irregular-feeling prostate suspicious for cancer, it may be more advanced and [we] want to catch them when they are earlier and so we really want to put more of an emphasis on the blood test, as it can suggest that something is wrong long before signs and symptoms develop,” Antoine said.

The PSA is a simple blood test that measures the level of prostate-specific antigen in the blood — elevated PSA levels can signal the presence of prostate cancer, which is the leading cause of death for men in Jamaica, and the most common cancer in the country. The DRE involves a gloved, lubricated finger inserted into the rectum to feel the prostate for abnormalities.

Dr Antoine’s call is similar to that of the British Association of Urological Surgeons (BAUS), which recently labelled the rectal exam a “poor test” for prostate cancer.

In a press release on June 9, 2025, the BAUS said that although the DRE was historically considered a standard test, the information from the rectal exam is of extremely limited value. The DRE only enables a 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most prostate cancer develops on the front wall of the gland, where it cannot be felt — so can easily be missed by this outdated test, the BAUS stated.

When asked why the DRE has historically been more widely promoted in Jamaica, Dr Antoine explained: “One reason for this may have been that there is a cost attached to doing the blood test, which is expensive…this would have made it a less popular method back then and the DRE is free, making it the more accessible and frequently used way of getting a man screened.”

Still, Dr Antoine emphasised that using both the PSA and DRE tests together remains the most effective method of screening for cancer.

The digital rectal exam has long had a social stigma around it, especially in Jamaica where homophobic attitudes are prevalent. However, urologist Dr Dean Wong said many men privately consent to exams with little hesitation.

“A lot of the talking is actually before and with men who have never actually had a prostate exam, but in the privacy of an office, a lot of them actually consent to it,” he told the Sunday Observer.

Dr Antoine noted a generally positive response from asymptomatic men who she believes may be more receptive because “they have already made up their minds” to do the exam.

She noted that this response may be, in part, because she is a woman.

“There are still going to be those die-hards not getting it done no matter what, but those are far and few between,” she said, also noting that younger men are increasingly proactive.

— See related story on Page 9

WONG…a lot of the talking is actually before and with men who have never actually had a prostate exam

ANTOINE…we really want to put more of an emphasis on the blood test, as it can suggest that something is wrong long before signs and symptoms develop