What Is A Prostate/rectal Ultrasound
A prostate or rectal ultrasound is an imaging test that uses sound waves tolook at your prostate or your rectum.
The healthcare provider uses a small probe called a transducer to make theimages of your prostate or rectum. The transducer is about the size of afinger. It is gently placed into your rectum, where it sends out soundwaves that bounce off your organs and other structures. The sound waves aretoo high-pitched for you to hear. The transducer then picks up the bouncedsound waves. These are made into pictures of your organs.
Your provider can add another device called a Doppler probe to thetransducer. This probe lets your provider hear the sound waves thetransducer sends out. He or she can hear how fast blood is flowing througha blood vessel and in which direction it is flowing. No sound or a faintsound may mean that you have a blockage in the flow.
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Examination Of Your Prostate Gland
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. They feel for any lumps or your prostate feeling larger than it should for your age. Doctors call this a digital rectal examination .
It’s normal to feel anxious about this test and it might be uncomfortable. But it usually only lasts a few minutes.
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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Information Needed To Diagnose An Enlarged Prostate
When you go to your appointment, bring information on your current symptoms, as well as a written record of your past medical problems.
Your healthcare provider will ask if you are having difficulty urinating, a weak stream, or nighttime urinating. They will aslo want to know if you’ve noticed blood in your urine or if there is burning .
You should also bring a complete list of all prescription and over-the-counter medicines that you are taking to see whether they are related to your symptoms. Certain drugs may interfere with urination. Over-the-counter medications, such as allergy and decongestant medicines, may prevent you from urinating. Other drugs that can make your symptoms more severe are opioids and anticholinergics.
Finally, tell your healthcare provider if you have a history of alcohol use. Alcohol can also interfere with urination.
Symptoms Of Prostate Cancer
In its early stages, prostate cancer doesnt necessarily cause symptoms. Men with prostate cancer might experience some of the following symptoms:
- needing to pee frequently or suddenly
- finding it difficult to pee, including trouble getting started or maintaining a strong or steady flow
- feeling like you havent completely emptied your bladder after going to the toilet
- pain, burning or discomfort when peeing
- or pain in the lower back, upper thighs, hips or chest
- feelings of weakness or numbness in the legs or feet
- unexplained weightloss
- feeling tired, short of breath or dizzy
- a rapid heart beat
Youll notice a lot of these symptoms are similar to symptoms of other conditions, including an enlarged prostate or prostatitis, which is why its important to always see your doctor if you notice any of these symptoms or changes.
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Trust The Urology Team At Lmh
If youre a man over 50, you need an experienced urologist on your care team. Theyre trained to check for prostate cancer and other urologic diseases, often before symptoms appear.
If youre experiencing urinary symptoms, Dr. Stephen Beck and Monica Davis, NP, will work with you to develop a customized treatment plan that restores your health and improves your quality of life.
Special Types Of Psa Tests
The PSA level from a screening test is sometimes referred to as total PSA, because it includes the different forms of PSA . If you decide to get a PSA screening test and the result isnt normal, some doctors might consider using different types of PSA tests to help decide if you need a prostate biopsy, although not all doctors agree on how to use these tests. If your PSA test result isnt normal, ask your doctor to discuss your cancer risk and your need for further tests.
Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free . The percent-free PSA is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.
If your PSA test result is in the borderline range , the percent-free PSA might be used to help decide if you should have a prostate biopsy. A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy.
Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers and helps some men avoid unnecessary biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level.
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When Should I Call My Healthcare Provider
If youre 50 and you havent had your first prostate exam yet, call your healthcare provider to set up an appointment. If youre at higher risk, such as if you’re Black or prostate cancer runs in your family, you should have your first prostate exam by age 45.
Furthermore, if you develop symptoms of urinary tract obstruction, schedule a visit with your provider right away. This may indicate an enlarged prostate, benign prostatic hyperplasia or a urinary tract infection.
A note from Cleveland Clinic
Most people are understandably apprehensive about their first prostate exam. Learning all you can about the process can help abate any fears or uncertainties you have. Talk to your healthcare provider about your screening options. A prostate exam is the first step in the early detection of prostate cancer and early detection is key to successful treatment.
Last reviewed by a Cleveland Clinic medical professional on 04/04/2022.
References
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.
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Biopsy During Surgery To Treat Prostate Cancer
If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .
The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.
What Happens During Your Gp Appointment
Your doctor needs to build up a picture of whats going on. So they will ask you some questions. These include:
- what symptoms you have
- when you get them
- whether anything makes them better or worse
They will ask you about your general health and any other medical conditions you have. They might arrange for you to have some tests.
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What Are The Limitations Of Prostate Ultrasound Imaging
Men who have had the tail end of their bowel removed during prior surgery are not good candidates for ultrasound of the prostate gland because this type of ultrasound typically requires placing a probe into the rectum. However, the radiologist may attempt to examine the prostate gland by placing a regular ultrasound imaging probe on the perineal skin of the patient, between the legs and behind the scrotum of the patient. Sometimes the gland can be examined by ultrasound this way, but the images may not be as detailed as with the transrectal probe. An MRI of the pelvis may be obtained as an alternative imaging test, because it may be obtained with an external receiver coil.
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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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What Do You Want Men To Know About Prostate Cancer
The important thing to know is that, if you live long enough, you will probably get prostate cancer. If you live into your 80s, about 80 percent of men have some sort of prostate cancer. That doesnt mean theyre going to die from prostate cancer because, as a percentage, very few men die from prostate cancer. It means its important to be aware of it and consider screening early, so if its a high-grade type, we can identify it and treat it.
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When Should I Get Tested
Visit Am I at Risk? to learn more. All men are at risk of prostate cancer, so it is important to talk with your doctor to make an informed decision. Check out our recommended age and testing guidelines, which are based on the NCCN provided recommendations.
Detecting prostate cancer early gives you the best chance of living longer. In fact, more than 99 percent of men survive prostate cancer when it is caught early.
Watch prostate cancer experts, Dr. Lowentritt and Dr. Siegel in this video discuss detection and diagnosis:
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What Would You Say To Men Who Dont Want To Get A Prostate Check
A rectal exam is recommended but optional. We recommend both, but if theyll just let you do a blood test, thats better than not doing anything at all.
If concern about the rectal exam is the only reason youre not getting screened, talk to your doctor about it. We can discuss the risks and benefits. None of the evaluation tests are mandatory, but the reason we do that is that it improves our ability to detect cancer. So, if thats why youre not being evaluated, we can talk and decide if we can do other tests.
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What Are The Symptoms Of Prostate Cancer
Not everyone with prostate cancer has symptoms, so regular screening should be a part of your annual physical, starting at the age of 40-50. However, prostate symptoms should never be ignored and should be brought up to a physician.
Typical symptoms of prostate cancer, according to the Prostate Conditions Education Council , include:
- Frequent urination
- Pain or burning during urination
- Bone pain in the hips, ribs or back
Read our guide to common pee problems that may be signs of prostate cancer if you are experiencing urination problems.
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Tests To Diagnose And Stage Prostate Cancer
Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.
If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.
The actual diagnosis of prostate cancer can only be made with a prostate biopsy .
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Benefits Of Screening In Studies Have Not Been Clear
Doctors are still studying if screening tests will lower the risk of death from prostate cancer. The most recent results from 2 large studies were conflicting, and didnt offer clear answers.
- Early results from a large study done in the United States found that annual screening with PSA and DRE did detect more prostate cancers than in men not screened, but this screening did not lower the death rate from prostate cancer. However, questions have been raised about this study, because some men in the non-screening group actually were screened during the study, which might have affected the results.
- A European study did find a lower risk of death from prostate cancer with PSA screening , but the researchers estimated that about 781 men would need to be screened to prevent one death from prostate cancer.
- Neither of these studies has shown that PSA screening helps men live longer overall .
Prostate cancer is often slow-growing, so the effects of screening in these studies might become clearer in the coming years. Both of these studies are being continued to see if longer follow-up will give clearer results. Prostate cancer screening is being studied in several other large studies, as well.
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What Happens During A Dre
The DRE will take place in a private exam room at your doctors 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 mans prostate is enlarged, there may be some discomfort or mild pain during the exam.
How Common Is Prostate Cancer
In the United States, the risk of a person with a prostate being diagnosed with prostate cancer is 11%. A person’s risk of dying from prostate cancer is 2.5%, and the average age that a person is when they die from it is 80.
Your risk for prostate cancer increases if you:
- Are over the age of 50 years old
- Are African American
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