Prostate Exams: Do You Really Need One
Prostate cancer, although the second most common cancer in men in the United States, is extremely treatable when it is detected in its early stages.
Recently, there has been debates in the medical community about whether or not the benefits of a prostate exam outweigh the risks. We asked Jeffery Spencer, MD, a Urologist at Finger Lakes Urology Institute for his expert opinion on prostate exams and prostate cancer screenings.
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.
Is Going To The Bathroom Frequently A Sign Of Prostate Cancer
Thats one of the challenging things having urinary symptoms is very rarelyalmost nevera sign of prostate cancer. Having urinary symptoms means you should probably be evaluated for an enlarged prostate, also known as benign prostatic hyperplasia . We can treat your urinary symptoms and help you pee better.
If urinary symptoms bring men to the doctor, we can discuss screening for prostate cancer. Thats important because not all men will go to a doctor until theres something wrong with them. And prostate cancer screening really is the only way to detect prostate cancer, because its almost always asymptomatic.
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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.
Men: Cancer Screening Exams By Age
These exams are for men at average risk of cancer.
Take this checklist to your next doctors appointment. Your doctor can help you develop a more tailored screening plan if needed.
These exams are for men at average risk of cancer. If you believe you may be more likely to develop cancer because of your personal or family medical history, visit our screening guidelines page to learn about exams for men at increased risk.
Ages 40-49
- Beginning at age 40, you should speak with your doctor about the benefits and limitations of prostate screening.
- If you choose prostate cancer screening, you should get a digital rectal exam and PSA test every year starting at age 45 to check for prostate cancer if you are African American or have a family history of prostate cancer.
Ages 50-75
- If you choose prostate cancer screening, you should get a digital rectal exam and PSA test every year to check for prostate cancer
- Colonoscopy every 10 years or virtual colonoscopy every 5 years to check for colorectal cancer
Age 76 and older
If youre age 76 to 85, your doctor can help you decide if you should continue screening. MD Anderson does not recommend cancer screening for men age 85 and older.
All Ages
Speak with you doctor about cancer screening exams for lung and skin cancers. Exams are available for those at increased risk.
Regardless of your age, practice awareness. This means you should be familiar with your body so youll notice changes and report them to your doctor without delay.
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Whats The Recommended Age For Your First Prostate Exam
Starting at age 50, all men should discuss getting a prostate exam with their doctor.
The reason for this is prostate cancer. In the UK, about one in eight men will be diagnosed with this in their lifetime. It mainly affects men aged 50 plus, but your risk increases as you get older, and the most common age to be diagnosed is between 65 and 69 years. Most men with early prostate cancer dont have any noticeable signs or symptoms.
The exception to this rule is if you are experiencing symptoms, or if your genetics predispose you as higher risk. Doctors are increasingly finding the tendency towards some prostate cancers can be inherited from your fathers family. Additionally, black men are at a higher risk, with one in four getting prostate cancer in their lifetime.
If youre experiencing no symptoms, heres the recommended age for prostate exam:
- If you have a family history, first prostate exam at age 40
- If you are black, first prostate exam at age 45
- If you have no family history and youre not black, first prostate exam at age 50
Should You Get A Prostate Exam
Ideally, you should discuss the pros and cons of getting a prostate exam with your doctor.
Cancer screening has risks you need to understand before starting the process.
One of them is overdiagnosis and experiencing undesired side effects of prostate biopsies.
There are more risks than benefits in prostate exams for patients above 70 years.
Thats why they are often advised against screening.
After 55 years, patients with urinary symptoms should get screened.
Those with a family history of prostate cancer may also require screening .
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When Should I Go Back
The answer to how often you should get a prostate exam depends on your medical history, but if youve got the all-clear, when you return depends on your age. The recommendations are as follows:
Age 50 59:
- If your PSA was between 1 and 3ng/mL: return every 2 to 4 years
- If your PSA was under 1ng/mL: return aged 60
Age 60 70:
What Age Should Men Be Screened For Prostate Cancer
The Prostate Cancer Foundation recommends that Black men or men with a family history of cancer be screened at the age of 40 otherwise, the organization advises getting screened at 45. The American Cancer Society recommends that men at “average risk” be screened at the age of 50, while “men at high risk of developing prostate cancer” like Black men and men who have a first-degree relative, like a father or brother, who were diagnosed with prostate cancer before the age of 65, be screened at 45. Men at “even higher risk” should be screened at 40.
In 2018, the U.S. Preventive Services Task Force issued a recommendation advising men to start talking about screenings with their doctors at the age of 55.
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Preparing For A Prostate Exam
Theres nothing special that you need to do to prepare for a prostate exam. Tell your doctor if you have anal fissures or hemorrhoids, as a DRE may aggravate these conditions.
If you decide to get a prostate cancer screening, your doctor will likely order a blood test, so inform the person drawing your blood if youre prone to dizziness.
Your doctor may ask you to sign a consent form before performing a cancer screening.
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 shouldnt 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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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.
If There Is A Family History Of Prostate Problems
If you have a family history of prostate problems, you may be at increased risk. You should, therefore, make sure you have regular checks in your 30s or 40sw upwards to reduce the risk of any problems arising. Make sure your doctor is aware of this family history so that he or she can provide advice and tips on getting your prostate checked. Many men do have a family history of prostate problems but they fail to go for regular checks, which then puts them at risk of developing issues that could otherwise have been avoided or tackled at an early stage.
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Prostate Cancer Screening Ages 40 To 54
The PSA test is a blood test that measures how much of a particular protein is in your blood. Its been the standardfor prostate cancer screening for 30 years.
Your doctor will consider many factors before suggesting when to startprostate cancer screening. But hell probably start by recommending the PSAtest.
While the general guidelines recommend starting at age 55, you may need PSAscreening between the ages of 40 and 54 if you:
- Have at least one first-degree relative who has had prostate cancer
- Have at least two extended family members who have had prostate cancer
- Are African-American, an ethnicity that has a higher risk of developing more aggressive cancers
What Do The Results Mean
PSA levels may be above the baseline for various reasons other than prostate cancer.
Other factors that can raise PSA levels include:
- older age
- an enlarged prostate â because of benign prostatic hyperplasia , for example
- prostatitis, which is inflammation and swelling of the prostate
Also, people with obesity may have lower PSA readings.
In addition, some medications may reduce PSA levels, including:
- 5-alpha reductase inhibitors, which can help treat BPH
- aspirin, which some people take regularly as a blood thinner
- statins, which help manage cholesterol levels
- thiazide diuretics, a kind of water pill that can help reduce high blood pressure
Some herbal medicines and supplements can also lower PSA levels. Tell the doctor about any medications and supplements before undergoing the test.
High PSA levels alone do not indicate cancer. However, if a DRE also reveals changes, a doctor may recommend a biopsy for a more accurate result.
The PCA3 is another test for prostate cancer that doctors use in some circumstances. Find out more.
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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.
When You Experienced Symptoms
Although prostate issues are more common in older men, they can strike at any age. You should, therefore, look out for symptoms of prostate problems. If you do notice any, you need to make an appointment to have your prostate checked. One of the common symptoms that could indicate a prostate issue is frequent urination.
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Prostate Cancer: When Should I Be Screened
Beginning at age 40, you should speak with your doctor about the benefits and limitations of prostate screening. If you choose prostate cancer screening, you should get a digital rectal exam and PSA test every year starting at age 45 to check for prostate cancer if you are African American or have a family history of prostate cancer. Ages 50-75. If you choose prostate cancer screening, you should get a digital rectal exam
Health & Wellnessal Roker Reveals Prostate Cancer Diagnosis
Rettig said that someone who has a “strong family history” of early onset prostate cancer might want to talk to their primary care provider or other health care practitioner earlier in life, while someone with less risk might prefer to wait.
The guidelines for how often men should be screened again also vary. If you have a high prostate-specific antigen , a protein made by cells in the prostate gland, you may be recommended to come back for more frequent screenings, but those with lower PSA levels might only be advised to come back every four years or so.
“If you’re 55 and have you have a PSA of less than one, you can wait four years to get screened again,” Rettig explained. “Alternatively, if you’re 45 and have a PSA of two and a half, that might be someone who might get a biopsy or be re-screened within the year. … How frequently one would be prescreened is really contingent upon the specifics of the patient.”
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Annual Prostate Exams Might Save Your Virility Your Continence Your Life
Its something most men of a certain age dread and has served as a popular topic of jokes for years, but one leading urologist for OSF HealthCare St. Francis Hospital & Medical Group in Escanaba, Michigan, sees a decline in men getting properly screened for prostate cancer as a real danger.
According to urologist Michael Harris, MD, all men over the age of 50 with a life expectancy greater than 10 years should get screened for prostate cancer every year. If you have a family history of prostate cancer or youre African-American, you should begin getting screened annually at the age of 40. Prostate cancer is very treatable, and the earlier its detected, the better.
The prostate sits in front of the rectum and below the bladder. It wraps around the urethra and makes the fluid part of semen. If you catch prostate cancer when the tumor is small, surgery to remove the tumor will result in less damage to the nerves and sphincter, which means you can better maintain your potency and continence.