What Happens During A Digital Rectal Exam
Your health care provider will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete.
You may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate.
When To See An Urologist For A Hard Prostrate
A hard prostrate is just one indicator that something is not quite right with the prostrate, hence the quick referral to a urologist. As Johsan mentions, PSA is another indicator, but not necessarily an indicator of prostate cancer. I expect the urologist will want to repeat the DRE and probably request an MRI scan and possibly a biopsy.
After a certain age, the doctor may recommend regular screening. A prostate exam can help detect cancer while it is still highly treatable, even if symptoms are not present. What is a prostate exam?
A biopsy may also be necessary to confirm or rule out cancer. Request a prostate-specific antigen test. Your doctor can order a laboratory test to check your PSA levels in the event of prostate abnormalities. Most doctors conclude a PSA level of 4ng/ml or lower is considered normal.
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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Incontinence And Erectile Difficulty
Treatment varies and can do more harm than good. Some urologists treat all cancers. Others follow a newer approach of surveillance, with regular re-testing, and possibly a repeat biopsy. Thus a well man can be converted into a possible cancer patient, getting regular tests, and being reminded that he might have a developing cancer. It is not surprising that many such men decide to have surgery, just to get the gland out, and save the anxiety.
Having surgery to remove the prostate is not a benign process. As with any operation there is a risk of complications. Some men will get infections, blood clots and a few will die.
After recovery, many men have urinary incontinence and erectile difficulty. It is hard to know the actual rates since measuring these is difficult: How much dribbling of urine, or how many embarrassing episodes of urgency should be counted to decide it is important? Measurement of all these outcomes is usually only published by the best centres that are willing to publicly describe their outcomes. There is wide variation across Canada: It appears that results are worse for many centres.
Everyone assumes that having the operation for early cancer will cure it.
Yes, it does, for a small proportion of men. The few trials available comparing surgery with not treating prostate cancer show a very small benefit for surgery. If you had an early cancer that would not develop, then the surgery cured you.
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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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.
Should You Get Your Prostate Checked
- James Dickinson, University of Calgary
Art credit: Vimeo
As Movember has come to a close, and men flaunt or shave the facial hair they have grown, there is something people should know prostate cancer screening is ineffective and can do more harm than good.Movember is a global charity that raises money for mens health. One of its key areas for fundraising and awareness is to advocate for prostate cancer testing with a PSA test.As a family physician and public health researcher, I am not getting a prostate cancer test: Neither a rectal examination nor a PSA blood test.
As a man of a certain age, I am likely to already have prostate cancer, and I know that suffering and even dying from this cancer is on the list of possible fates that await me. My choice is not because I have my head in the sand. It is because, after studying the evidence, I know that a test will likely not improve my outcome.
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Why Should You Check Your Psa Levels
You should consider early screening for prostate cancer because the prevalence of prostate cancer is on the rise.
For prostate cancer, the most typical age of diagnosis is when a man is in his mid-sixties. Its very unusual to ever see it before the age of 40 unless there a man is at high risk for prostate cancer.
Regardless, we know that for each decade a man lives, the chance of getting prostate cancer goes up.
According to the American Cancer Society, at least 1 in 9 men in the United States will be diagnosed with prostate cancer which works out mathematically to about 175,000 new diagnoses per year in the U.S. right now. A little over 30,000 men will die from prostate cancer this year in the United States. Prostate cancer is second only to lung cancer as the leading cause of cancer death in men, in the United States.
Early detection is key in receiving appropriate and timely treatment. For men who choose to use PSA testing as their chosen method, the volume of PSA vs. the testing range varies. According to the Mayo Clinic, men with a PSA volume of less than 2.5ng/ml may need to be retested every two years, for men with a reading of over 2.5ng/ml, they should get tested each year.
Men who take a PSA test should bear in mind that they also may need a digital rectal exam as part of their screening.
The PSA test can offer insight into whether further testing should be pursued following early onset symptoms and
You should consider taking a PSA test if:
Symptoms Of Prostate Cancer
Symptoms of prostate cancer do not usually appear until the prostate is large enough to affect the tube that carries urine from the bladder out of the penis .
When this happens, you may notice things like:
- an increased need to pee
- straining while you pee
- a feeling that your bladder has not fully emptied
These symptoms should not be ignored, but they do not mean you have prostate cancer.
It’s more likely they’re caused by something else, such as prostate enlargement.
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What’s A Raised Psa Level
The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood .
If you’re aged 50 to 69, raised PSA is 3ng/ml or higher.
A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that’s not cancer, such as:
There Are Risks To Getting Prostate Cancer Tests And Treatments
If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
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What Do You Say To Patients Diagnosed With Prostate Cancer
Something I say to my patients a lot is that, in treating prostate cancer, we end up trying to extend your quantity of life at the cost of your quality of life. And so, at some point, if the quantity is extended a lot, and we can minimize the effect on quality, that makes sense, but the equation is different for every man. How much decrease in quality of life are you willing to accept if were going to extend your life?
Realistically, a lot of guys who are 70 dont have any sexual function anyway, so thats not a huge loss for them. As men get older theres definitely an increased chance of having erectile dysfunction the guys who have sexual function over 70 are very keen on preserving it. Even for the guys who dont have good sexual function, who are on Viagra, for them its often even more important to preserve what sexual function they have.
Examination Of Your Prostate
When your doctor examines you it might include feeling your prostate gland. To do this your doctor puts a gloved finger into your back passage to check for abnormal signs, such as a lumpy, hard prostate. Doctors call this test a digital rectal examination .
It’s normal to feel a bit anxious about this test and it might be uncomfortable. But it usually only takes a few minutes.
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How Does Prostate Pain Feel Like
In addition, you may have pain around the base of the penis and behind the scrotum, pain in the lower back, and the feeling of a full rectum. As the prostate becomes more swollen, you may find it more difficult to urinate, and the urine stream may become weak.
What Is Prostate Cancer
The prostate is a gland that is usually the size and shape of a walnut. It sits under the bladder and surrounds the urethra . Itâs main job is to help make semen. It grows as you get older.
Prostate cancer causes abnormal cells to develop in the prostate gland which creates a tumour and can sometimes spread to other parts of the body.
Sometimes the cancer will grow too slowly to cause any problems or affect how long you live. You may never need any treatment.
However, some types of prostate cancer are very aggressive and are more likely to grow and spread quickly. This seems to be even more likely in black men. This will require treatment to stop it spreading.
Most men with early prostate cancer donât have symptoms. You can check your risk using the Prostate Cancer UK Risk Checker.
If you notice changes in how you urinate, it might not be prostate cancer, but itâs best to get it checked out. Early symptoms could be:
difficulty starting to urinate or emptying your bladder
a weak flow when you urinate
a feeling that your bladder hasnt emptied properly
dribbling urine after you finish urinating
needing to urinate more often than usual, especially at night
a sudden need to urinate you may sometimes leak urine before you get to the toilet.
More advanced symptoms or signs that the cancer has spread could be:
back pain, hip pain or pelvis pain
problems getting or keeping an erection
blood in the urine or semen
unexplained weight loss.
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Should I Have A Prostate Cancer Screening Test
Routine testing for prostate cancer in all men without symptoms is not recommended in New Zealand at present. Being tested for prostate cancer is your choice. Learning about the pros and cons of prostate testing can help you decide if it is right for you.
To help you decide if a prostate check is right for you, the Ministry of Health has developed the Kupe website. It will help you understand the risks, benefits and implications of prostate testing, so you can have an informed conversation with your doctor.
If you are unsure about whether you need to get tested for prostate cancer, contact your GP for a discussion on the risks and benefits of testing.
When To Startand Stopscreening
The doctors and researchers who recommend screening argue that cases of prostate cancer found very early can be cured more quickly, with less chance of relapse or spread. Those who recommend against routine screening point to the slow-moving nature of prostate cancer and the side effects of surgical and medical treatment, which can be considerable.
The introduction of PSA screening in the US led to an initial increase in the number of prostate cancer cases diagnosed each year, even though many of these new cases were non-aggressive or low-risk prostate cancer. The issue was not that screening was harmful, it was that many of these low-risk cancers did not necessarily need immediate treatment. It seems strange to say that a patient might be better off leaving cancer untreated, but in some cases, it can be true. For a few years, the United States Preventative Services Task Force recommended against PSA screening. We are now seeing more cases of advanced prostate cancer diagnosed in recent years. This may be a long-tail effect of that USPSTF recommendation. It has now been changed to note that for men aged 55 to 69 years, the decision to undergo PSA screening is an individual one and should be discussed with your doctor. USPSTF continues to recommend against screening for men aged 70 and over.
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How Often Do I Need A Prostate Exam
Prostate cancer is one of the most common types of cancer in men, and its also highly treatable if caught early. There are a number of treatment options that have proven to be successful in combatting prostate cancer, even in its advanced stage.
Early detection is crucial because it gives you more treatment options and a better chance of eliminating cancer. The prostate-specific antigen test is used to check the PSA levels in your blood, and these levels are different for every man the indicator is whether the number is going up as compared to your prior PSA exam result. If your PSA is high the first time you have the test, your doctor may ask you to have a biopsy.
Similarly, your doctor will perform a digital rectal exam during your annual checkup to feel for any lumps or enlargement of your prostate. Lets talk about how often you might need to have a prostate exam and what you can expect.
Why You Should Get Your Prostate Checked Earlier Rather Than Later
Nothing is better than having a peace-of-mind, especially regarding health concerns. For men in particular, as they age one common cause of stress they will have to worry about is potential prostate problems. The prostate is located just below the urinary bladder and in front of the rectum. The prostate is a male reproductive gland that helps to produce semen. As men age, the prostate can enlarge and cause major problems. For instance, Prostatitis affects upward of 50% of men in their lifetime. Some common prostate conditions include bacterial infection, dribbling after urination, Prostatitis, Prostate Cancer, and many more. Doctors can provide cancer screenings to help detect symptoms before problems arise, and when dealing with your health it is best to be in the know and keep yourself protected. Here are three reasons to consider getting yourself checked earlier rather than later on.
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