What is the cause of the “rectal refusal syndome” in the early detection of prostate cancer?


it is better to be quite and appear dumb, than to speak and remove all doubt.

Why men won’t have a rectal explained with humor in a cartoon. I have personally heard these examples from patients. 

What is interesting about this study is that:

  • Older more educated men more likely to agree to get screened
  • Younger and employed men are less likely
  • Of the men who declined the rectal many would not tell why
  • Those who did say why they declined a rectal said it was “embarrassing.”
  • And finally a point that I am in total agreement about…we need to do more about getting all men recognize the importance of the “awareness of prostate cancer.” Until we do, men showing up in their fifties with prostate cancer too late to cure will continue to occur.
  • Embarrassing? Give me a break!

Why Do Men Refuse Prostate Cancer Screening? Demographic Analysis In Turkey

15 Dec 2008

UroToday.com – Prostate cancer is one of the most common cancers in men, with a high incidence rate in Turkey. However, the early detection and diagnosis rates are considerably lower among Turkish men as compared with their counterparts in Western countries. This fact reflects a lack of awareness and fear of prostate cancer as well as low participation in prevention activities. To reduce the disparities in prostate cancer survival, there is a great need to increase men’s participation in screening programs.

The present study was performed to assess why men do not seek screening or participate in screening programs, focusing on the demographics of men refusing free screening programs for prostate cancer.

The sample size (n: 747) was determined using the Systematic Random Sampling Method (95 Confidence and 2% Standard Error) among men over 40 years of age who lived in the Osmangazi region (n: 3285). All were enrolled in the study in a 20-month period and asked to complete questionnaires Then they were invited to attend a public health center to consider having a PSA test and DRE for prostate cancer. Two different questionnaire forms were applied during the study. In the first, the socio-demographic characteristics of subjects were evaluated with 23 questions. The second questionnaire was comprised of the International Prostate Symptom Score Form (IPSS form). Serum PSA level, DRE characteristic, TRUS and TRUS-guided biopsy results were recorded in a third form. Serum PSA value and DRE were used for prostate cancer screening. The screening procedure was conducted by a urologist. If the men had any abnormality on PSA value (4.0ng/mL<) and/or DRE, the results were subjected to further investigation (including TRUS and prostate biopsy). Prostate cancers were finally detected in five subjects.

Although all of men (n: 747) responded to the questionnaire forms, only 35.2% of men accepted DRE (n: 263). Subjects were divided in two groups (accepted or refused) for analysis. Participants in the 40-49 year age group were less likely to attend the screening than older ages (p<0.05), and the level of participation increased with age (p<0.05). Men graduating from high school were more likely to go for screening than men with less than a high school diploma and college and above (p<0.05). Retired men were more likely to participate than employed men (p<0.01). There were no significant differences in marital status and health insurance between refusing and attending groups. Although participation increased with the I-PSS score, there was no statistical significant association with urinary symptoms. At the end of the free prostate cancer screening program all the questionnaire forms of the participants who refused were examined from the point of view “what would make it challenging for the men to get free prostate cancer screening?”. About 51% of those who refused failed to give a reason for not participating in a free prostate cancer screening, and while 25% made an appointment, Digital Rectal Examination was not accepted. The other barriers to prostate cancer screening included embarrassment about DRE (5.8%) and other reasons.

Since this screening program was free of charge, we eliminated cost, lack of knowledge, and not having a regular doctor by free charge and informed consent. However, our findings suggested that there were some possible reasons for refusing to participate in prostate cancer screening and few barriers were reported. The current study revealed that in the 50-59 years age bracket, high school graduates and retired men were more likely to participate in prostate screening. Especially, 65.8% (n=173) of retired men participated in screening versus 34.2% (n=90) of employed men.

There are some limitations to the study. The sample was small; this being the first study related to free prostate cancer screening and barriers in Turkey.

 Future research needs to examine how we can assist men in overcoming the barriers they describe. Future efforts should be directed at increasing awareness about screening procedures for prostate cancer.

Written by Esin Ceber, MD as part of Beyond the Abstract on UroToday.com

UroToday – the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

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Copyright © 2008 – UroToday


One Reply to “What is the cause of the “rectal refusal syndome” in the early detection of prostate cancer?”

  1. Embarassed over a simple DRE? Really try being a woman and having your legs held up in the air by metal stirrups. Then you get to have your inner private places prodded with instruments that often cause pain. We women feel like the Christmas turkey being stufed. We submit to this, very often, on a yearly basis because we don’t want to die of cancer.
    GENTLEMEN, suck it up and get with it. Catching prostate cancer early prevents an extremely painful death.


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