How Do Men Feel About The Rectal Exam
I think most men are willing to do it, but some men are exceptionally opposed to it. They might be happy to hear that there are studies ongoing in the United Kingdom looking at using magnetic resonance imaging as a screening tool to be able to avoid doing a digital rectal exam in the future. There is a large African immigrant population in London with a higher incidence of prostate cancerthey didnt want to have the prostate exam because they had a lot of opposition to it. They were uncomfortable with it.
Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
Use In Men Who Might Have Prostate Cancer
The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.
PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.
- Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
- Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
- If the PSA is more than 10, the chance of having prostate cancer is over 50%.
If your PSA level is high, you might need further tests to look for prostate cancer.
To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.
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Benefits And Risks Of Screenings
The benefit of any cancer screening test is to find cancer early, when it easier to treat. But the value of PSA screening for prostate cancer is debated. No single answer fits all men.
Prostate cancer often grows very slowly. PSA levels can begin to rise years before a cancer causes any symptoms or problems. It is also very common as men age. In many cases, the cancer will not cause any problems or shorten a man’s life span.
For these reasons, it is not clear if the benefits of routine screenings outweigh the risks or side effects of being treated for prostate cancer once it is found.
There are other factors to think about before having a PSA test:
- Anxiety. Elevated PSA levels does not always mean you have cancer. These results and the need for further testing can cause a lot of fear and anxiety, even if you do not have prostate cancer.
- Side effects from further testing. If your PSA test is higher than normal, you may need to have a one or more biopsies to find out for sure. A biopsy is safe, but can cause problems such as an infection, pain, fever, or blood in the semen or urine.
- Overtreatment. Many prostate cancers will not affect your normal life span. But since it is impossible to know for sure, most people want to get treatment. Cancer treatment can have serious side effects, including problems with erections and urinating. These side effects can cause more problems than the untreated cancer.
What Tests Do Health Care Professionals Use To Diagnose Prostate Cancer
The diagnosis of prostate cancer ultimately is based on the pathologist’s review of tissue removed at the time of the prostate biopsy. An abnormal PSA and/or abnormal digital rectal examination often are present and are the indications for the prostate biopsy.
Digital rectal examination : As part of a physical examination, your doctor inserts a gloved and lubricated finger into your rectum and feels toward the front of your body. The prostate gland is a walnut or larger sized gland immediately in front of the rectum, and beneath your bladder. The back portion of prostate gland can be felt in this manner. Findings on this exam are compared to notes about the patient’s prior digital rectal examinations.
The exam is usually brief, and most find it uncomfortable due to the pressure used to adequately examine the prostate gland. Findings such as abnormal size, lumps, or nodules may indicate prostate cancer.
The National Comprehensive Cancer Network notes that a DRE should not be used as a stand-alone test for detection of prostate cancer but should be performed in men with an elevated PSA. The NCCN also notes that DRE may be considered as a baseline test in all patients, as it may help identify high-grade cancers associated with a normal PSA.
If the PSA level is elevated or has increased significantly over time, further testing may be needed to rule out prostate cancer.
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What If My Test Results Are Abnormal
If the results of early detection tests like the PSA screening or the digital rectal exam suggest that you might have prostate cancer, your doctor will conduct further testing. The PSA may be repeated, or you may be sent to a specialist for more tests such as a transrectal ultrasound and a prostate biopsy.
In a prostate biopsy, a tissue sample is taken from your prostate. Cancer can only be diagnosed with a tissue sample.
Recent research has yielded additional tests that in addition to the PSA and subsequent DRE and Biopsy that can give a doctor more information on to determine the probability of both finding cancer during a biopsy and determining how aggressive that cancer is likely to be. Read more on those tests.
Who Should Get A Digital Rectal Exam
Not all medical institutions agree on when men should begin screening for prostate cancer or even if a DRE should be part of the screening.
To help detect prostate cancer in its early stages, the American Cancer Society recommends that men talk to their doctors about the benefits, risks, and limitations of prostate cancer screening before deciding whether to be tested.
For most men at average risk, discussions about screening begin at age 50. However, some doctors recommend that men at higher risk of prostate cancer — African-American men or men with a family history of prostate cancer — start screening earlier.
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When To See A Urologist About Enlarged Prostate
The signs and symptoms of an enlarged prostate become more evident as a man ages. An enlargement of the prostate can signal Benign Prostatic Hyperplasia a noncancerous, but bothersome condition that affects more than half of men in their 50s and up to 90% of men in their 70s and 80s.1,2 However, the severity of these symptoms does not necessarily correlate with the severity of the enlargement of the prostate. In fact, many men who have serious enlargement of the prostate may only have mild symptoms and vice versa. That means that it is advisable for men who experience urinary symptoms to see their urologist early.
Additional Links
Attention to these problems may help avoid serious interference in their lifestyle, such as the often embarrassing urgency and frequency of urination. A proactive physician visit may also allow for early diagnosis or even prevention of a more serious prostatic condition. LUTS can be a sign of prostatitis or even prostate cancer. Most men experiencing urinary symptoms or over the age of 50 will benefit from regular prostate exams.
Visiting a urologist at the earliest stages of enlargement has the following benefits:
1 National Institute of Diabetes and Digestive and Kidney Diseases. Prostate enlargement: benign prostatic hyperplasia. NIH Publication No. 07-3012. June 2006.
2 Carter HB. Prostate Disorders: The Johns Hopkins White Papers. Baltimore, MD: Johns Hopkins Medicine 2013:1-25.
Psa Test: The Current Prostate Screening Standard
Before recommending when you should be screened for prostate cancer, yourdoctor will consider many factors, such as:
- Age
- Family history, particularly whether any of your family members have had prostate cancer
- Race, as African-American men have a higher risk of developing prostate cancer
If your doctor determines you should undergo screening, he or she will mostlikely recommend the PSA test. For more than 30 years, the PSA test hasbeen the gold standard in prostate cancer screening. This simple blood testmeasures how much prostate-specific antigen is in your blood.
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Surgery For Prostate Cancer
There are many types of surgery for prostate cancer. Some are done to try to cure the cancer others are done to control the cancer or make symptoms better. Talk to the doctor about the kind of surgery planned and what you can expect.
Side effects of surgery
Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know so they can help you.
How Should I Prepare For The Exam
You should tell your doctor if you have hemorrhoids, anal tears, or other problems with your anus. The exam will be easier if you breathe normally and try to relax.
Before having a PSA test, tell your doctor about any medications and supplements you take. Recent ejaculation can also affect your PSA levels. Ask your doctor if you should abstain from sexual activity before the test.
Your blood must be sent to a laboratory for analysis, so your PSA results wont be available immediately. Your doctor will let you know when they have the results.
The lab report will show the level of PSA in your blood as:
In addition to looking at the amount of PSA in your blood, your doctor will assess how quickly this number is changing. Many things can affect PSA, so test results require careful analysis by an expert. Your doctor will take all of your health information into account.
If you have an abnormal PSA test result, it doesnt mean you have prostate cancer. Most men with a high PSA level dont have prostate cancer. About 25 percent of men who have a biopsy due to a high PSA level have prostate cancer.
Its also possible for men with prostate cancer to have normal DRE and PSA test results.
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Why Does Prostate Cancer Happen
The causes of prostate cancer are largely unknown. But certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men aged 50 or older.
For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in Asian men.
Men whose father or brother were affected by prostate cancer are at slightly increased risk themselves.
Recent research also suggests that obesity increases the risk of prostate cancer.
Questions You Might Want To Ask Your Gp
- Do I need to see a specialist? Is it urgent?
- When will I see them?
- Where will I see them?
- Will I find out about my appointments by post or telephone?
- Do I need tests? What will they involve?
- How long should I expect to wait?
- Where can I find out more about tests?
- Do I have to do anything in preparation for this test?
- When will I get the results and who will tell me?
Your GP might not be able to answer all of your questions. They will tell you what they can at this point. Not knowing is difficult to cope with and can make you anxious.
Speaking to a friend or relative about how you feel might help.
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Whats The Best Treatment For Prostate Symptoms
Treatments for prostate cancer include surgery to remove the prostate, radiation therapy, and ablation therapies, as well as active surveillance. Some treatments are better for some men and some prostates than others. There are side effects for each, so it really requires an informed discussion to help each man make an educated decision.
One thing we do at Yale is use an MRI of the prostate to evaluate the location of the prostate cancer for surgical planning. Ive found it to be quite helpful. Its not done everywhere.
Getting The Results Of The Biopsy
Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:
- Positive for cancer: Cancer cells were seen in the biopsy samples.
- Negative for cancer: No cancer cells were seen in the biopsy samples.
- Suspicious: Something abnormal was seen, but it might not be cancer.
If the biopsy is negative
If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.
But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:
- Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
- Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.
Prostate cancer grade
Gleason score
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Further Testing For Advanced Cancer
If there’s a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.
These include:
- an MRI scan, CT scan or PET scan these scans build a detailed picture of the inside of your body
- an isotope bone scan, which can tell if the cancer has spread to your bones a small amount of radiation dye is injected into the vein and then collects in parts of the bone where there are any abnormalities
Discuss Prostate Cancer Testing With Your Doctor
Medical authorities do not recommend that all men should be tested for prostate cancer. In fact, most authorities suggest that men should make their own choice about whether or not to have a PSA test. If you decide to be tested, it is recommended that it should be done every two years from 50 to 69 years of age, and only if your health is such that you expect to live for at least another seven years.
Men at high risk of prostate cancer, such as men with a family history of prostate cancer , or men who have previously had an elevated test result, can start two-yearly testing from age 45. Your doctor can help you decide whether this is necessary.
While there is now some evidence that regular testing may prevent prostate cancer deaths, there are concerns that many men may be diagnosed and treated unnecessarily as a result of being screened, with a high cost to their health and quality of life .
However, the option of active surveillance, where a low-risk cancer is watched closely instead of being treated, helps to lower these risks. Active surveillance is now used quite commonly in Australia for men with low-risk prostate cancer.
If you are unsure whether or not to be tested after considering the benefits and uncertainties of testing and your own risk of prostate cancer, discuss it with your doctor.
In Australia, if you choose to be tested for prostate cancer the tests are covered by Medicare.
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Prostate Exam In Concord Mint Hill And Charlotte
Some men are hesitant about getting tested, but a skilled urologist will give you confidence and knowledge about maintaining your prostate health. Dr. Richard Natale is here to help you maintain optimum sexual health and overall health as well.
If you have any questions or would like to schedule an appointment with Dr. Natale, contact our friendly staff at Carolina Urology today by calling 786-5131 or by filling out our appointment request form online now. We look forward to serving you.
Medical History And Physical Exam
If your doctor suspects you might have prostate cancer, he or she will ask you about any symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.
Your doctor will also examine you. This might include a digital rectal exam , during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if its only on one side of the prostate, if its on both sides, or if its likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.
After the exam, your doctor might then order some tests.
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