Does A Dre Always Detect Prostate Abnormalities
A digital rectal examination allows a doctor to feel only the back wall of the prostate gland, so any abnormalities located in the middle or front part of the gland cannot be felt. For this reason, the DRE is performed in conjunction with PSA testing. Although the PSA test can detect many cancers which doctors cannot feel during a DRE, it has also been shown that DREs detect some cancers which are not associated with an elevated level of PSA in the bloodstream.
Repeating The Psa Test
A mans blood PSA level can vary over time , so some doctors recommend repeating the test after a month or so if the initial PSA result is abnormal. This is most likely to be a reasonable option if the PSA level is on the lower end of the borderline range . For higher PSA levels, doctors are more likely to recommend getting other tests, or going straight to a prostate biopsy.
What Are The Most Common Diagnoses You Find In Patients
As a sexual health specialist, I see erectile dysfunction, low testosterone and male infertility.
One of the most surprising things I find in many patients is Peyronies disease penile curvature that develops due to trauma. This is quite common but rarely talked about. Patients who come in for this often have never heard of it, and many of them think they are the only person who has this.
This disease causes painful erections, and many men opt not to treat it out of a sense of shame. But if you suspect you have it, early treatment can help limit or improve symptoms. Peyronies disease generally does not go away on its own, so please talk to a urologist if you notice any symptoms.
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What Happens After A Prostate Exam
After the exam, the doctor can tell you straight away whether everything felt normal with your prostate. However, sometimes the prostate can feel fine even though there might be a problem. It can also have abnormalities caused by something other than cancer, such as inflammation or benign prostate enlargement.
This is why your prostate exam is often combined with a blood test called a PSA test. It looks for levels of a certain enzyme, which, if higher than normal, can be a sign of cancer.
It usually takes between 1-2 weeks to get the results back. Your prostate exam and PSA will determine whether any further tests are needed and help the doctor decide how regularly you need to be checked in the future.
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Predictive Value Of Dre As A Function Of Psa Range
Among the 8367 men who were in fact screened by all three tests, data for those who had a positive DRE and were screened by biopsy examination are shown in . Those men who also had an elevated PSA level or a suspicious TRUS result are included. Overall, 970 biopsies were used to diagnose 264 cancers with a positive predictive value of 27% 82 cancers would have remained undetected by PSA-based screening alone. We assumed that all participants who had an abnormal DRE and were found to have cancer would have been diagnosed with an abnormal DRE alone. This assumption seems justified because the same biopsy procedure was used for all participants with an elevated PSA, an abnormal TRUS, or an abnormal DRE.
With PSA values of 0-3.9 ng/mL, the positive predictive values range from 4% to 33%, with an average of 12.8%. Thus, 7.8 biopsies must be done to find one cancer. With PSA values of 0-2.9 ng/mL, the positive predictive values range from 4% to 11%, with an average of 8.8%. The situation changes drastically in those men whose PSA values are greater than or equal to 3.0 ng/mL. The positive predictive value increases to 49.6%, and two biopsies must be done to find one cancer. Detection rates, however, are dramatically lower with DRE alone and strongly depend on PSA levels. Thus, the performance of DRE is strongly dependent on PSA levels and is poorest when the PSA level is less than 3.0 ng/mL, an area that is considered the domain of the DRE.
Fig. 2.
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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.
Concerns About Prostate Cancer Screening
If prostate cancer is found as a result of screening, it will probably be at an earlier, more treatable stage than if no screening were done. While this might make it seem like prostate cancer screening would always be a good thing, there are still issues surrounding screening that make it unclear if the benefits outweigh the risks for most men.
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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.
Should I Poop Before A Prostate Exam
You dont need to change any bathroom habits prior to your appointment. If you feel like you need to poop before your exam, then its fine to do so. But dont worry if you just dont have the urge. The prostate exam shouldnt make you feel like you need to go.
Theres no need to be embarrassed about fecal matter during your prostate exam. Your healthcare provider is experienced in performing this exam and will do everything to ensure your comfort during the process.
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Predictive Value Of Dre
Our data indicate that the DRE has a low positive predictive value in men with low PSA levels. This result is due to the low prevalence of the disease and the low sensitivity of the screening procedure. When PSA levels are less than 3.0 ng/mL, 11 biopsies are necessary to detect one cancer. If it were certain that those cancers detected in this PSA range pose a significant threat to the patient’s life, this burden might be acceptable . Selective screening for potentially aggressive lesions is important. Many prostate cancers detected in men with PSA levels of less than 4.0 ng/ mL do not show the characteristics of aggressive disease by volume and grade of differentiation. A large proportion of the tumors detected may not be immediately clinically relevant and would probably be detected through subsequent screening, as suggested by Carter et al. . Since a PSA level of less than 4.0 ng/mL does not indicate the need for a biopsy, for PSA levels less than 4.0 ng/mL in this study, one might expect that cancers found by DRE and/or TRUS are larger, clearly palpable, and visible tumors that do not produce much PSA, a feature often associated with poor differentiation. The contrary, however, is the case.
Screening Tests For Prostate Cancer
Screening is testing to find cancer in people before they have symptoms. Its not clear, however, if the benefits of prostate cancer screening outweigh the risks for most men. Still, after discussing the pros and cons of screening with their doctors, some men might reasonably choose to be screened.
The screening tests discussed here are used to look for possible signs of prostate cancer. But these tests cant tell for sure if you have cancer. If the result of one of these tests is abnormal, you will probably need a prostate biopsy to know for sure if you have cancer.
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The Prostate Exam Procedure
Your doctor will likely begin by asking if you are currently experiencing any prostate health related symptoms such as a weak urine stream, dribbling or straining to urinate. Your doctor may also inquire as to whether your family has a history with prostate cancer, and if the doctor doesnt ask, volunteer the information. Here are the two tests that will be done:
- Digital rectal exam :A digital rectal exam is a clinical examination of the prostate gland by way of the rectum to check for any abnormalities and is an essential element in screening for and identifying prostate cancer. While the exam can be uncomfortable, if not a little undignifying, a rectal exam shouldnt hurt.
- PSA blood test:A visit for a prostate exam may also involve a blood test, The PSA test is a blood test which is used primarily to screen for prostate cancer. The test measures for the amount of prostate-specific antigen in your blood which is a protein produced by both cancerous and noncancerous tissue in the prostate. Following the completion of the blood test it may take a few days to get the results.
What Does Prostate Cancer Screening Entail
There are two types of prostate cancer screening exams and both should be done in conjunction with the other: A digital rectal exam and a prostate-specific antigen blood test .
A DRE is a physical exam in which the physician lubricates a gloved finger to gently examine the patients rectum. If it is enlarged or irregular in shape, the doctor will be able to easily detect it. While it may be uncomfortable, the test brief and can be life-saving.
A PSA test is a blood test that measures the level of prostate-specific antigens in the blood. Rising levels of PSA can be one of the first signs of prostate cancer, allowing for early detection and treatment.
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European Randomized Study Of Screening For Prostate Cancer
Data were obtained from the prevalence screen in the Rotterdam section of ERSPC for a 33-month period starting on July 1, 1994. The screening algorithm used was applied in a prospective fashion as part of the original protocol. The goals and structure of ERSPC are described elsewhere . A summary of the screening procedures and the participants is given in . Men of ages 54-70 years are randomly assigned to screening or no screening. The main end point of the study is prostate cancer mortality. When this report was being written , more than 30 000 men in Rotterdam, more than 110 000 men in Europe, and more than 190 000 men internationally through the International Prostate Screening Trial Evaluation Group had been randomly assigned.
Fig. 1.
CONSORT diagramscreening procedure and participants.
Digital Rectal Examination For Prostate Cancer
A digital rectal examination , performed as part of an annual physical checkup, is one of the most important tests for the early detection of prostate cancer. Because the prostate gland is located just in front of the rectum, it cannot be felt from the outside of the body.
During the DRE, a doctor inserts a lubricated, gloved finger into the patient’s rectum to feel for lumps, enlargements, or areas of hardness that might indicate prostate cancer. The procedure lasts for less than minute and, while uncomfortable, should cause no pain. However, a painful examination could indicate the presence of other, benign conditions, such as prostatitis.
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Risks And Benefits Of Prostate Cancer Screening
There are two main benefits of prostate cancer screening.
One is potentially preventing death from prostate cancer. Many men have prostate cancer without experiencing symptoms, so screening can potentially identify prostate cancer early on when it can be treated more easily.
Another benefit of screening and early detection is potentially catching prostate cancer in its early stages, allowing for more effective treatment. Earlier treatment can help prevent prostate cancer from spreading beyond the prostate , which can cause several symptoms.
Unfortunately, there are drawbacks to prostate cancer screening. The DRE is not very sensitive or specific. This means that people who have prostate cancer can still have a normal DRE, while patients with an abnormal DRE may not have prostate cancer. For these reasons, healthcare providers are no longer performing DRE alone for routine prostate cancer screening and relying instead on the PSA test .
PSA testing also has limitations in screening for prostate cancer. Elevated PSA levels do not only occur in prostate cancer. Prostatitis or an enlarged prostate can also cause PSA levels outside the normal range. Abnormal test results can ultimately lead to undue anxiety and further testing that may prove unnecessary .
Another problem with the PSA test is the potential for overdiagnosis and overtreatment. Screening uncovers patients with prostate cancer who would otherwise never have had any issues resulting from the disease.
Study Population And Screening Procedures
Participants are recruited from the population registry of Rotterdam and from surrounding communities. The invitation to participate is by letter. Written informed consent is required by Dutch law. The participation rate varies around 45%. The participation rate is defined as the number of men who have been randomly assigned to screening divided by the number of men who were invited to participate. Process evaluation was carried out. Questionnaires administered to participants and refusers alike indicated that the frequency of prostatic symptoms in the two groups was equal. This finding suggests no selection bias on this account. Rescreening is carried out once after 4 years in the ERSPC protocol.
This study is based on 11 500 participants in the Rotterdam section of ERSPC who were randomly assigned to the screening arm during the period from 1994 through 1997, of whom 10 523 were actually screened. In February 1996, the protocol was changed so that men who had PSA levels of less than 1.0 ng/mL were not screened by DRE and TRUS. Of 3858 men with PSA values of less than 1.0 ng/mL, 1702 were recruited before this change and 2156 were recruited after this change .
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What Should I Expect During A Prostate Exam
As mentioned above, there are two types of screenings that your healthcare provider may use to detect prostate cancer: a PSA blood test and a digital rectal exam . Research shows that the PSA blood test is more effective for detecting prostate cancer. However, the DRE can still find cancer in people with normal PSA levels. For this reason, many healthcare providers recommend both.
Neither test confirms you have prostate cancer, which is why theyre considered screening assessments rather than diagnostic tests.
PSA blood test
For this test, your healthcare provider simply draws a sample of your blood and sends it to a lab for analysis. The PSA blood test measures the amount of prostate-specific antigen in your blood.
There is no official cutoff score that can determine whether or not you have prostate cancer. Instead, the results are used as a gauge to determine if more testing is needed.
If you have a high PSA, you may need further testing such as a prostate biopsy, MRI or other lab tests to determine if prostate cancer may be present.
Digital rectal exam
During a DRE, your healthcare provider inserts a lubricated, gloved finger into your rectum. This way, they can feel your prostate to see if there are any lumps or bumps on the back portion of the gland .
Possible Inaccurate Or Unclear Test Results
As an example, neither the PSA test nor the DRE is 100% accurate. These tests can sometimes have abnormal results even when a man does not have cancer , or normal results even when a man does have cancer . Unclear test results can cause confusion and anxiety. False-positive results can lead some men to get prostate biopsies when they dont have cancer. And false-negative results can give some men a false sense of security even though they might actually have cancer.
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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.
Using The Digital Prostate Exam To Screen For Cancer
Author: Brian Hildebrandt, Last Updated: July 26, 2019
After the age of 40, its generally recommended your doctor perform a digital prostate exam to check for signs of prostate cancer.
Alongside your PSA test, it can help towards an early diagnosis of prostate cancer.
Now, I can imagine what youre thinking. Theres no f-ing way Im letting a doctor stick his finger where the sun dont shine!
Fair enough, I agree its an uncomfortable procedure.
But the benefits of living a long happy life far outweigh dying early and leaving your wife and children alone. Dont they?
You have a 1 in 6 chance of developing prostate cancer in your life time. Its important you treat this seriously.
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