Who Should Be Screened
Prostate cancer is most common in older men, and rates are highest in men aged 75-79. Statistics show that ethnicity is a risk factor and black men are more likely to develop it. Youre also more at risk if a close relative has had it before they reached the age of 65.
As it develops without symptoms, its a good idea to get screened from the age of 50.
If you are at a very high risk eg if youve got more than one close relative who has developed prostate cancer before they reached 65, you should start getting screened at 40.
If you are black or you have one close relative who developed prostate cancer at a young age, you should start getting screened at 45.
Before You Leave For Your Appointment It Can Be Helpful To:
- Make a list of medications and supplements you take
- Write down the symptoms youve been having, noting when and where you notice them
- Write down any questions you have for the nurse or urologist
- At your appointment, you might be asked to:
- Provide a urine sample. Go to your appointment with a full bladder!
- Fill out a questionnaire about your symptoms
- Answer questions about your medical history
- Provide a list of your medications, including any supplements and herbs you may take
Do Men Ejaculate During Prostate Exams
Kneeblock said:I’m here having an argument with my girl here because she says her ex used to ejaculate everytime he got a prostate exam.I’ve only had one and was near tears. Are there any more seasoned prostate pros who can tell me whether this ever happens or if her ex was a dolo.Dr. if ever there was a time where you could feel like going to medical school was worth it, answering this question would be the moment.
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What Secondary Tests Are Available To Me
Various secondary testing methods are at your disposal should you need more information before engaging in shared decision-making with your physician about further prostate cancer screening. It could also be helpful if your PSA test or rectal exam results place you in a “gray area” of risk for prostate cancer.
- PSA free-to-total-ratio, or prostate health index : can help improve the accuracy of the standard PSA test by discerning whether your risk of having prostate cancer is as low as 10% or as high as 50%.
- PSA velocity: If you’ve had previous PSA tests, your physician will look at them to determine how quickly your PSA levels have changed over time. A steep PSA level increase over a short period often correlates with a prostate cancer diagnosis, Ruckle says.
- Urine tests: One of which detects PCA3, a noncoding RNA gene that is only in your prostate. Too many copies of PCA3 in the urine indicate a greater chance of having prostate cancer.
- MRI of the prostate to image for biopsy targets.
Based on any of these results, the doctor will recommend a prostate biopsy if they suspect cancer.
What Happens During A Rectal Examination
First, you’ll be asked to undress from the waist down. If you’re wearing a loose skirt, you can usually just remove your underwear.
Let the doctor or nurse know if you’d like to get changed behind a curtain or be alone in the room.
The doctor or nurse will:
If you’re a man, the doctor or nurse may press on your prostate. This can make you feel the urge to pee, but it should not hurt.
Once you’re dressed, they’ll discuss the results of the examination with you.
Page last reviewed: 23 December 2020 Next review due: 23 December 2023
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What Is The Prostate
The prostate is a walnut-shaped gland that is part of the male reproductive system. It has two or more lobes, or sections, enclosed by an outer layer of tissue. The prostate is located in front of the rectum and just below the bladder, where urine is stored. It surrounds the urethra at the neck of the bladder and supplies fluid that goes into semen.
When Should You Get A Prostate Exam Age And Other Risk Factors
There are a number of different factors that determine when you should get a prostate exam, and your personal decisions about screenings should always be based on conversations with your doctor. In fact, the American Cancer Societys guidelines for prostate exams are actually recommendations of when to discuss prostate screenings with your doctor, rather than firm statements regarding when the screenings should be done.
In any case, these are the ages at which the ACA recommends men have a discussion with their doctor about beginning regular prostate exams:
- At age 50 for men who are at an average risk of developing prostate cancer.
- At age 45 for men who are at a higher risk for developing prostate cancer. This includes African-American men , as well as men who have a first-degree relative such as a father or brother who were diagnosed before they were 65.
- At age 40 for men who fit an extremely high risk factor, i.e. with more than one close relative who was diagnosed with prostate cancer at an early age.
Once you and your doctor have determined when you should begin to receive regular prostate exams, a PSA blood test may be used to determine how often you should get a prostate exam. You can learn more about the PSA test in our Ultimate Prostate Health Guide but in short, PSA is a protein produced by prostate cells which, when elevated, may be indicative of prostate cancer, or may be the result of a benign condition like BPH or prostatitis. According to the ACAs guidelines:
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What Is Screening For Prostate Cancer
Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.
Cancer screeningexternal icon means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.
If you are thinking about being screened, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your personal risk factors.
There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.
What To Expect During The Digital Rectal Exam
Your doctor may examine you either standing or lying down.
- If standing, you will be asked to stand facing the examination bed, with feet apart, body bent forward and your arms or elbows on the bed. Feel free to ask your doctor to give you a heads up before making any sudden movements.
- Wearing surgical gloves, the doctor will coat a finger in lubricant.
- The finger will be inserted into your rectum in a downwards angle. You may feel a little pressure or slight discomfort, but it shouldn’t hurt. It is important to relax and take deep breaths and let the doctor know immediately if there is pain.
- Your doctor may have to wait a few seconds for your external sphincter muscle to relax, and may ask you to bear down as if you are having a bowel movement.
- The doctor moves the finger in a circular motion in order to identify the lobes and groove of the prostate gland. The doctor checks for:Lumps on or around the prostate
- Swelling
- Hard spots or bumps
- Abnormalities on the prostate
- A normal prostate is usually around 2-4 cm long and has a triangular shape, with a firm and rubbery texture
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What Would You Tell Men Who Are Opposed To Having Things Put In Their Rear End
Fred: Without being too forward or rude, just grow up and give it a go. The stigma around it is so incredibly strong, mostly because it goes against the masculine trend of only putting your dick in things, but seriously itll change your life. Youll never wanna orgasm any other way again.
Alan: While its certainly valid and not everyones favorite cup of tea, the sensations offer a wider range of pleasure to bring into the bed with yourself or with your partner. If you are searching for something new to try, this is a sensation that all people with a prostate can enjoy.
Evan: I would say to men who are reticent to put things up their ass that they are probably fearful because of societal pressures/expectations. They need to look at their prostate as an important part of their body and sexuality to explore.
Drew: I would say you’re really missing out! Take some time to reflect on why you’re not open to exploring this amazing pleasure center. Does it rub up against your ideas of masculinity and what it means to be a man? Do you have anxiety related to the other fluids and substances that might be down there? Are you afraid of exploring this with your partner and what they might think? If any of these are coming up I would recommend starting small and solo: small size toys, or preferably your own finger. The prostate is a gift, celebrate and cherish it!
*Name has been changed to allow subject to freely on private matters.
What Kind Of Doctor Will I See For A Dre
A primary care doctor or a gynecologist usually does a DRE. A gynecologist is a doctor who specializes in the health of women’s reproductive system. Other types of doctors, including gastroenterologists, surgeons, and oncologists may do DREs. A gastroenterologist is a doctor who specializes in the gastrointestinal tract. An oncologist is a doctor who treats cancer.
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What Is A Digital Rectal Exam
The most common way for doctors to check on the health of your prostate is with a DRE. Its a fairly quick and simple procedure.
For the exam, youll bend at the waist while standing or lie on your side with your knees bent toward your chest.
Your doctor will lubricate a gloved finger and gently place it inside your rectum. Theyll press one hand on your prostate, and their other hand will feel your pelvic area. It should only take a few moments.
You may experience momentary discomfort. You may also feel the urge to urinate, especially if your prostate is enlarged or inflamed.
Your doctor will be able to tell you if your prostate seems to be a normal size and shape. In general, a DRE has no risks.
Weighing Your Options For Treatment
If you test positive for prostate cancer, you have some options as to what youd like to do about it. Until recently, nearly everyone opted for surgery or radiation, while some patients choose not to undergo treatment, instead opting for active surveillance, during which the cancers are left alone but regularly monitored to be certain that theyre not growing.
Certainly, screening can lead to earlier prostate cancer detection, and with earlier detection, youre eligible for multiple different treatments or active surveillance, said Sia Daneshmand, MD, associate professor of urology at Keck School of Medicine of USC and director of urologic oncology at the USC Institute of Urology at Keck Medicine of USC. So we encourage patients who are candidates for screening to discuss it with their urologist and/or primary care physician so that we can determine whats the best course of treatment for them.
There also is a new option for those seeking prostate cancer treatment. Its called High-Intensity Focused Ultrasound , which uses ultrasound beams to non-surgically destroy prostate tumors.
If you are in the Los Angeles area, schedule an appointment with one of our urologists by calling or by visiting Urology.KeckMedicine.org/request-an-appointment.
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Factors That Might Affect Psa Levels
One reason its hard to use a set cutoff point with the PSA test when looking for prostate cancer is that a number of factors other than cancer can also affect PSA levels.
Factors that might raise PSA levels include:
- An enlarged prostate: Conditions such as benign prostatic hyperplasia, a non-cancerous enlargement of the prostate that affects many men as they grow older, can raise PSA levels.
- Older age: PSA levels normally go up slowly as you get older, even if you have no prostate abnormality.
- Prostatitis: This is an infection or inflammation of the prostate gland, which can raise PSA levels.
- Ejaculation: Thiscan make the PSA go up for a short time. This is why some doctors suggest that men abstain from ejaculation for a day or two before testing.
- Riding a bicycle: Some studies have suggested that cycling may raise PSA levels for a short time , although not all studies have found this.
- Certain urologic procedures: Some procedures done in a doctors office that affect the prostate, such as a prostate biopsy or cystoscopy, can raise PSA levels for a short time. Some studies have suggested that a digital rectal exam might raise PSA levels slightly, although other studies have not found this. Still, if both a PSA test and a DRE are being done during a doctor visit, some doctors advise having the blood drawn for the PSA before having the DRE, just in case.
- Certain medicines: Taking male hormones like testosterone may cause a rise in PSA.
Some things might lower PSA levels :
Treating Blood In Semen
The treatment your GP or urologist recommends will depend on what they think is the underlying reason for the blood in your semen.
In many cases, particularly if you have no other symptoms or the blood in your semen was an isolated incident, no treatment is necessary and the problem will usually resolve on its own.
If a clear reason is identified, the treatment youre offered will depend on the specific cause.
For example, you may be given antibiotics to treat an infection and cysts may need to be drained with a needle.
If theres a serious underlying cause, such as a blood clotting disorder or cancer, youll be referred to an appropriate specialist for any necessary treatment.
Page last reviewed: 18 July 2019 Next review due: 18 July 2022
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Prostate Specific Antigen Test
A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.
As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.
PSA levels also can be affected by
- Certain medical procedures.
What Are Additional Tests For Detecting Prostate Problems
If the DRE or the PSA blood test indicates a problem may exist, the health care provider may order additional tests, including urinalysis, urodynamic tests, cystoscopy, abdominal ultrasound, transrectal ultrasound with prostate biopsy, and imaging studies such as magnetic resonance imaging or computerized tomography scan.
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Experts In Urology Care
If you are experiencing symptoms consistent with urinary issues, we urge you to complete our urologic cancer risk assessment form.
Not everyone should get a PSA test. Why? Because many men in this country are treated for low-risk prostate cancer that is discovered through the PSA test, even when it is unlikely that the disease will ever cause symptoms or lead to death. And treatment is associated with significant side effects, including impotence and incontinence . So a PSA test is recommended only for men who might be at greater risk for dying of prostate cancer for example, younger men with a family history of prostate cancer or African-American men.
To avoid the risks of over-treatment, Roswell Park follows the guidelines established by the National Comprehensive Cancer Network . The NCCN brings together world-renowned experts from 30 of the nations top cancer centers to write guidelines that specify the best ways of preventing, detecting and treating cancer. The guidelines are updated at least every year, on the basis of the latest research.
Michael Kuettel, MD, PhD, MBA, Chair of Roswell Park’s Department of Radiation Medicine, serves on the NCCN Prostate Cancer Panel.
The NCCN recommends that only men in these categories receive a PSA test for early detection of prostate cancer:
What Do The Dre Results Mean
A digital rectal examination is a test used to see if you might have a prostate problem or prostate cancer.
Your prostate may feel:
- normal a normal size for your age with a smooth surface
- larger than expected for your age this could be a sign of an enlarged prostate
- hard or lumpy this could be a sign of prostate cancer.
The DRE is not a completely accurate test. Your doctor or nurse cant feel the whole prostate. And a man with prostate cancer might have a prostate that feels normal.
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