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Rectal Exam Prostate Cancer Screening

What Is A Prostate Exam

What it’s like to go for a rectal screening for prostate cancer

A prostate exam is a screening method used to look for early signs of prostate cancer. In general, a prostate exam includes a PSA blood test and a digital rectal exam .

During the digital rectal exam portion, your healthcare provider carefully inserts their gloved finger into your rectum. This allows them to feel the edges and surface of your prostate gland to detect any potential abnormalities.

Screening Information For Prostate Cancer

Screening for prostate cancer is done to find evidence of cancer in otherwise healthy adults. Two tests are commonly used to screen for prostate cancer:

Digital rectal examination

A DRE is a test in which the doctor inserts a gloved, lubricated finger into the rectum and feels the surface of the prostate through the bowel wall for any irregularities.

PSA blood test

There is controversy about using the PSA test to look for prostate cancer in people with no symptoms of the disease. On the one hand, the PSA test is useful for detecting early-stage prostate cancer, especially in those with many risk factors, which helps some get the treatment they need before the cancer grows and spreads. On the other hand, PSA screening may find very-slow-growing prostate cancers that would never threaten someone’s life. As a result, screening for prostate cancer using PSA may lead to treatments that are not needed, which can cause side effects and seriously affect a person’s quality of life.

ASCO recommends that people with no symptoms of prostate cancer and who are expected to live less than 10 years do not receive PSA screening. For those expected to live longer than 10 years, ASCO recommends that they talk with their doctor to find out if the test is appropriate for them.

Other organizations have different recommendations for screening:

Population Observations Of Early Detection Incidence And Prostate Cancer Mortality

While digital rectal exam has been a staple of medical practice for many decades, prostate-specific antigen did notcome into common use until the late 1980s for the early diagnosis of prostatecancer. Following widespread dissemination of PSA testing, incidence rates rose abruptly. In a study of Medicarebeneficiaries, a first-time PSA test was associated with a 4.7% likelihood of aprostate cancer diagnosis within 3 months. Subsequent tests were associatedwith statistically significant lower rates of prostate cancer diagnosis.

In an examination of trends in prostate cancer detection and diagnosis among140,936 White and 15,662 African American men diagnosed with prostate cancerbetween 1973 and 1994 in the National Cancer Institute’s Surveillance, Epidemiology, and End Results database, substantial changes were foundbeginning in the late 1980s as use of PSA diffused through the United States age at diagnosis fell, stage of disease at diagnosisdecreased, and most tumors were noted to be moderately differentiated. ForAfrican American men, however, a larger proportion of tumors were poorlydifferentiated.

  • Legler JM, Feuer EJ, Potosky AL, et al.: The role of prostate-specific antigen testing patterns in the recent prostate cancer incidence decline in the United States. Cancer Causes Control 9 : 519-27, 1998.
  • Perron L, Moore L, Bairati I, et al.: PSA screening and prostate cancer mortality. CMAJ 166 : 586-91, 2002.
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    What Is The Dre Procedure

    A DRE is a straightforward and painless clinical exam. There may be some natural discomfort, but it is temporary.

    No preparation is required, there is no need for anaesthetic and there is no risk to the patient. However, it is advisable to evacuate the intestines before the exam so that they are empty.

    So, what should I expect on the day of the exam?

    The patient lies on their back with their legs bent.

    The stages of the exam are as follows:

  • The doctor begins by lubricating his finger well after putting on a glove.

  • The top, bottom and sides of the prostate, as well as the surface, are massaged by the end of the finger.

  • In this way, the size of the prostate, presence of nodules and hard areas and/or other abnormalities can be assessed easily and immediately.

    Is It Necessary For Primary Care Practitioners To Discuss The Benefits And Harms Of Screening With Their Patients

    Why a one

    If patients raise the issue of PSA screening, physicians should discuss the benefits and harms associated with screening. Men should understand that undergoing a PSA test can lead to additional testing if the PSA level is raised. Tools outlining the harms and benefits of screening are available on our Harms and Benefits page.

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    Benefits Of Early Detection And Treatment

    The goal of screening for prostate cancer is to identify high-risk, localized prostate cancer that can be successfully treated, thereby preventing the morbidity and mortality associated with advanced or metastatic prostate cancer.

    Adequate evidence from randomized clinical trials shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened.3, 4 Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened.3 Current results from screening trials show no reductions in all-cause mortality from screening. There is inadequate evidence to assess whether the benefits for African American men and men with a family history of prostate cancer aged 55 to 69 years are different than the benefits for the average-risk population. There is also inadequate evidence to assess whether there are benefits to starting screening in these high-risk groups before age 55 years.

    Adequate evidence from RCTs is consistent with no benefit of PSA-based screening for prostate cancer on prostate cancer mortality in men 70 years and older.

    The Most Common Prostate Cancer Screening Method Is Obsolete

    Prostate cancer, the second-most common cancer among American men, will kill an estimated 26,000 American men this year, according to the American Cancer Society. But the truth is, most men dont need to undergo an annual exam for it, and they especially dont need to subject themselves to the oldest and most commonly used way to screen for it: the digital rectal exam.

    For one, its less than pleasant: A doctor inserts one gloved, lubricated finger into a mans rectum to feel for any bumps or hard areas on the prostate gland to determine if the patient should have further testing for prostate cancer.

    In addition to being unpleasant, the exam may also put up barriers between men and regular medical care. About one in five men say that uncomfortable body exams like this rectal screening keep them from making an annual appointment with a doctor.

    Now, a new study claims that it isnt as effective as the newer PSA test, which measures the amount of a prostate-specific antigen in the blood. If PSA levels are elevated, it could indicate that a man has prostate cancer.

    Dr. Ryan Terlecki, a urologist from Wake Forest Baptist Medical Center in North Carolina, led a team that reviewed past research and data from a prostate cancer screening trial of about 38,000 men who received both the PSA test and the DRE annually for three years. They found that the rectal exam did not improve outcomes for most men compared to the PSA test.

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    Why Do I Need A Digital Rectal Examination

    Why do I need a digital rectal exam as part of prostate cancer screening?

    Most early prostate cancers cause no symptoms and are found only through early detection by a digital rectal examination and a prostate-specific antigen test. Recent studies indicate that the combination of DRE and PSA testing is more effective in the early detection of prostate cancer than either procedure is on its own.

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    But Theres A Reason To Be Wary Of Psa Tests Too

    Its important to note that PSA is also produced naturally by the prostate, which means high readings could simply be because the prostate is enlarged or inflamed for reasons that have nothing to do with cancer, such as infection or aging.

    False positive PSA tests at best worry men, and at worst result in unnecessary surgery or other cancer treatment for a tumor that wouldnt otherwise be deadly. While exact numbers are difficult to come by, data from large trials estimate that prostate cancer screening results in overdiagnosis rates of 17 to 50 percent, according to the U.S. Preventive Services Task Force.

    Because of the high risk of false positives, the task force recommended in 2012 to stop routine PSA testing among men in all age groups.

    Quality And Risk Of Bias Assessment

    All 7 studies were considered to have possible risk of bias according to the QUADAS-2 criteria . Lack of clarity surrounding participant enrollment methods in the majority of studies made it difficult to judge conferred risk of bias or applicability concerns in the patient selection domain. Similarly, risk of bias and applicability for the index test domain were difficult to determine because not all studies explicitly stated their criteria for an abnormal DRE. All 7 studies were deemed to have high risk of bias in the flow and timing domain, as only patients with an abnormal PSA or DRE underwent the reference standard test .

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    Getting A Prostate Biopsy

    For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.

    For more details on the prostate biopsy and how it is done, see Tests to Diagnose and Stage Prostate Cancer.

    For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.

    Asymptomatic Patients Presenting For Consideration Of Psa Testing

    Cpt Code For Digital Rectal Exam

    PSA testing in asymptomatic men for the purpose of prostate cancer screening is controversial because of the risk of overdiagnosis and overtreatment of tumours that would not cause harm in a persons lifetime.5,27 Potential harms include biopsy complications , and treatment side-effects that affect quality of life.5,27 Refer to the Controversies in Care section below for more information about the risks and benefits of PSA testing in asymptomatic men.

    Asymptomatic men at average risk

    Asymptomatic men aged 55-69 years, who have greater than 10 years life expectancy, may decide to pursue PSA testing. An informed discussion about the risks and benefits of testing is recommended.14,27

    Refer to the and Resources sections below for prostate cancer risk calculators and patient decision aids to support an informeddiscussion.

    If an asymptomatic patient decides to undergo PSA testing and results are within the appropriate agebased reference range, further testing in less than 2 years is not indicated. This is not an insured benefit in BC under the Medical Services Plan . If a patient-pay PSA level is abnormal, repeat PSA testing is an insured benefit.

    PSA testing is not indicated in asymptomatic patients < 55 or > 69 years of age who are without risk factors. The value of screening in men < 55 years has not been adequately addressed in the large screening trials. There is likely little benefit to screening in men 70 years or older.

    Asymptomatic men with risk factors

    Digital rectal exam

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    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

    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.

    Patient Population Under Consideration

    This recommendation applies to adult men in the general US population without symptoms or a previous diagnosis of prostate cancer. It also applies to men at increased risk of death from prostate cancer because of race/ethnicity or family history of prostate cancer. The sections below provide more information on how this recommendation applies to African American men and men with a family history of prostate cancer.

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    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.

    Screening Tests For Prostate Cancer

    Urologist Reacts to TRY GUYS Getting a DIGITAL RECTAL EXAM | Prostate Cancer Screening

    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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    What If I Am Diagnosed With Prostate Cancer

    Many people have been where you are standing. Dont lose hope. More than 3.1 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.


    Response To Public Comment

    A draft version of this recommendation statement was posted for public comment on the USPSTF website from April 11 to May 8, 2017. A number of comments suggested that because men are now living longer, they should be screened beyond 70 years of age. However, the USPSTF considered other evidence in addition to data on life expectancy when recommending against screening in men older than 70 years, including results from large screening trials that did not report a mortality benefit for men older than 70 years and evidence on the increased likelihood of harm from screening, diagnostic evaluation, treatment, overdiagnosis, and overtreatment. Several comments requested a recommendation for younger men and for baseline PSA-based screening in men 40 years and older or 50 years and older. The USPSTF found inadequate evidence that screening younger men or performing baseline PSA-based screening provides benefit.

    Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Authors followed the policy regarding conflicts of interest described at . All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

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    Both Tests Are Better Than One


    Using these tests together is better than using either test alone. PSA testing together with a DRE may help find a dangerous cancer early when it is easier to treat.

    Follow-up tests

    If a problem is found, more tests will be done to find out whether you have prostate cancer or another health problem. Further tests can include:

    • a follow-up PSA test
    • a transrectal ultrasound a test that uses sound waves to make a picture of the rectum and nearby organs, including the prostate
    • a biopsy of the prostate tissue samples of the prostate are looked at under a microscope

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