Screening For Prostate Cancer
Prostate cancer is typically treatable if caught early. More than 90 percent of prostate cancers are found when the disease is in the beginning stages, confined to the prostate and nearby organs.
Unlike screenings for breast and colon cancers, there are no universal screening guidelines for prostate cancer. The U.S. Preventive Services Task Force recommends that men age 55 to 69 weigh the benefits and risks before deciding whether they should undergo screening, which is typically performed with a blood test that measures levels of a protein called prostate-specific antigen .
However, men in high-risk groupssuch as those who are of African-American descent and/or have a first-degree relative diagnosed with prostate cancer before age 65should consider speaking with their doctor about starting screenings at an earlier age.
Men older than 70 shouldnt be routinely screened for prostate cancer, according to the USPSTF.
Regardless of age or risk factors, men should get checked if they suddenly experience issues with urination, erectile dysfunction or unexplained pain.
The USPSTF suggests that, before deciding on a screening, men should seek expert advice about the benefits and harms of screening. Risks may include:
- False positives
- Complications and side effects from biopsies to confirm a diagnosis
- The possibility that a prostate cancer diagnosis wont extend lifespan or improve quality of life
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
- 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
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 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.
What Is The Outlook
It is difficult to give an outlook . Your symptoms may last a long time, although they may come and go or vary in severity. Painkillers can keep discomfort to a minimum.
Most men diagnosed with chronic prostatitis/CPPS tend to have an improvement in their symptoms over the following six months. In one study, about a third of men had no further symptoms one year later. In another large study, one third of men showed moderate to marked improvement over two years.
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Who Should Get A Prostate Exam
Starting at age 50, all men should discuss prostate cancer screening with their doctor. The American Cancer Society advises men at higher risk to have this conversation at age 45.
Youre considered to have an increased risk if youre African-American or if a first-degree relative had prostate cancer before age 65. If more than one first-degree relative had prostate cancer before age 65, you might want to consider beginning prostate cancer screening even earlier.
Prostate cancer is easier to treat before it spreads. However, some prostate cancers are so slow-growing that they dont always require treatment. A lot depends on your age and other factors.
Discuss your risk factors with your doctor, and ask if you should have a prostate exam as part of your yearly checkup.
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.
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When Should I Have A Prostate Check
Generally, if you aged 50 years or older and have any urinary symptoms, you should let your doctor know. They will discuss with you whether or not you should have a prostate check.
- poor flow of urine
- trouble stopping peeing
- dribbling after you are done peeing
- needing to pee more often, at night or urgently
- trouble starting peeing
- pain when peeing
- blood in your pee.
If you have no symptoms, it is recommended that you get checked if you:
- you are a man aged 5070 years old but dont have any family history
- you are a man aged 4070 years old and your father or brother has had prostate cancer
- you are a man aged more than 70 years old and you have family history of prostate cancer or you have had an abnormal PSA test previously, and you have a life expectancy of more than 10 years.
Having a prostate check is your decision. The tests for prostate cancer can be uncomfortable but they may reduce your chance of being harmed or dying from prostate cancer.
If your test results suggest you are at risk of cancer, you will need to decide whether to have further testing and possibly treatment. In making this decision, you will need to consider whether your quality of life will be better living with a slow growing cancer than having treatments, which may cause you more harm than the cancer ever will.
Your doctor can help you weigh up the benefits and risks of being tested, by taking into consideration factors such as your age and family history.
If They Don’t Think You Need Any Tests Or A Referral
- Can you explain why I dont need to have tests or see a specialist?
- Is there anything I can do to help myself?
- Do I need to see you again?
- Who do I contact if my symptoms continue or get worse, especially during the night or at weekends?
- I’ve been reading about prostate cancer and wish to have a PSA test can you explain why I dont need one?
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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.
What To Expect During Cystoscopy
The procedure generally takes about 15 to 20 minutes.
- Youâll need to pee first. The test is done with an empty bladder.
- Youâll lie down. The position depends on the type of scope your doctor uses:
- Standard rigid cystoscope. Youâll lie on your back with your knees up and apart. Your feet will probably be in stirrups.
- Flexible cystoscope. No special position is needed. The doctor will help you find a comfortable position.
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What If I Am Diagnosed With Prostate Cancer
Many people have been where you are standing. Dont lose hope. More than 2.9 million American men have been diagnosed with prostate cancer and are alive today.
The first thing you should consider doing is to find out about the specifics of your cancer. You should know your stage and grade .
From there you can find out what treatment options you want to pursue, if any. Talk to your doctors. Choose a healthcare team of different specialists, or consult a second opinion. You can also do your own research, or talk to men who have been in your position. Many of our advocates are patients and survivors hear their stories at the video library. Or head to the rest of our website to start some research.
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.
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How To Tell If Your Cancer Has Metastasized
Prostate cancer metastasis may be suspected if you have specific symptoms such as new lower back pain or elevated liver enzymes. These may be signs your cancer has spread to your spine or your liver, respectively. If your prostate-specific antigen levels continue to rise despite treatment, especially if they are rising particularly fast, this may be a sign that cancer is metastasizing somewhere in your body.
Ruling Out Prostate Cancer
If you have symptoms of BPH, your doctor might also test for prostate cancer. An early examination is important because only a comprehensive exam will determine whether you have BPH, which is a benign condition, or whether you have prostate cancer, which is best to diagnose early. Important tests for detecting prostate cancer include a digital rectal examination and prostate-specific antigen test.
- Digital rectal examination : During this test, your urologist will feel your prostate. The exam shows whether your prostate is hard or asymmetrical, both of which can be signs of cancer, or soft, which is less likely to indicate cancer. Your urologist will insert a lubricated, gloved finger into your rectum. If your doctor feels anything that may indicate prostate cancer, you may need to have more tests to make an accurate diagnosis.
- Prostate-Specific Antigen Test: This blood test measures a protein produced by the cells of the prostate gland. It is always done and evaluated in conjunction with a DRE.
It is important to recognize that a high PSA reading alone does not mean that you have cancer. An elevated PSA could be a sign of a number of conditions, including BPH, or prostatitis, an inflammation of the prostate. There is no evidence that prostatitis and BPH cause cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
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Genetic Testing For Some Men With Prostate Cancer
Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.
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.
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.
There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.
Prostate Cancer: Advancements In Screenings
Dr. Christian Paul Pavlovich
You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.
What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.
Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.
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Growth Of Cancer Cells
Depending on different factors such as the health of the patient and side effects, the doctor can decide to check for the presence of cancer cells on the prostate. The prostate gland is located just close to the rectum.
The doctor will use a lubricated and gloved finger to feel the growth of the cells. The finger is driven through the rectum to the prostate for the doctor to feel if there are cells on the prostate gland. It is rather an uncomfortable but simple process.
What Happens During A Dre
The DRE will take place in a private exam room at your doctor’s office. The test only takes a few minutes. You will need to take off any clothes below your waist. You will be given a gown to wear or a cloth to wrap around your body.
For men. The doctor will ask you to stand and bend forward at the waist or they will ask you to lie on your side on an exam table with knees pulled up to your chest. As they start the DRE, the doctor may ask you to relax and take a deep breath. Then they will gently insert a lubricated, gloved finger into your rectum. The doctor will feel the size of your prostate gland. They will also feel for bumps, soft or hard spots, or other abnormal areas. The doctor will also examine the wall of your lower colon and rectum.
For women. The doctor will usually ask you to lie on your back on an exam table. Your feet will be in raised stirrups. The doctor may ask you to relax and take a deep breath as they start the DRE. Then they will gently insert a lubricated, gloved finger into your rectum. The goal is to feel your reproductive organs and the bowel. The doctor may also feel for problems in your internal organs. They do this by pressing on your lower abdomen or pelvic area with their other hand.
A DRE usually does not hurt, but you may be uncomfortable. You may also feel the need to urinate. If a man’s prostate is enlarged, there may be some discomfort or mild pain during the exam.
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