Purpose: Determine the incidence of clinically significant prostate cancer (CaP) in patients referred to Urology Clinic with an abnormal Digital Rectal Examination (DRE) and a Prostate Specific Antigen (PSA) level below referral threshold. Methodology: 195 patients were referred for an abnormal DRE to Christchurch Urology clinic between 04/09/2019 and 04/12/24. Patients were excluded if they had a PSA exceeding threshold (15), pre-existing CaP (6), unlocatable clinic letters (10), a cancelled referral (1), incorrect classification of their referral (14) or incomplete investigations (1). We reviewed whether patients’ DREs were abnormal in clinic, their investigations, whether CaP was diagnosed, and if patients underwent active or conservative management. Results: Of the 148 included patients, 106 had a normal DRE in clinic. 105 of these patients were discharged. One patient was referred for MRI, which was normal. Ten comorbid patients did not undergo DRE in clinic and were managed conservatively. 32 patients had an abnormal DRE in clinic, of whom one was clinically diagnosed with CaP, 18 were referred for MRI and 13 directly for biopsy. In total, 23 patients were diagnosed with CaP. Five patients had ISUP 1 disease, five had ISUP 2, four patients had ISUP 3, one patient had ISUP 4 and five patients received a diagnosis without formal histology. Three patients underwent prostatectomy and nine underwent radiation treatment. Four patients are under active surveillance and seven had conservative management. Conclusion: 23 patients out of 148 (15.5%) were diagnosed with CaP following a referral for abnormal DRE. Only 12 patients proceeded to radiation therapy or prostatectomy (8%). This suggests DRE is a low yield investigation for identifying clinically significant CaP in patients with a PSA level below referral threshold.