Types Of Prostate Exams
There are two universal prostate screening methods, the PSA and DRE. The PSA, or Prostate-Specific-Antigen test, measures the amount of PSA in a mans blood. PSA is a protein produced by the prostate cells and constantly circulates through the blood.
The PSA has been controversial for misdiagnoses in the past, and the benefits of early detection must be weighed against false results. The test is highly sensitive and often detects a cancerous presence too small to be considered life-threatening. There is no standard PSA level. Some men with low levels have prostate cancer, while other men with high levels of PSA do not have cancer, hence the confusion over PSA test results. So, an upward trend in PSA readings over multiple tests suggests concern over the actual PSA level itself.
A digital rectal exam is where your urologist inserts a gloved finger into your rectum to palpate your prostate and check for any lumps and other irregularities. This quick and painless test can tell a lot about a mans prostate health.
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If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
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Why Members Skip The Exam
Men skip prostate exams for many different reasons. Members may:
- Be uncomfortable with the stigma surrounding the exam
- Fear a cancer diagnosis
- Believe the downsides of a false positive outweigh the benefits
- Not believe they’re at risk
- Equate being asymptomatic to being cancer-free
Some members could simply be confused by the changing recommendations for testing. This is why medical professionals suggest consulting a doctor.
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When Should You Start Getting Prostate Checks
Many men suffer from prostate problems at some point in their lives and prostate issues are very common, particularly in older men. There are various health issues that can occur ranging from an enlarged prostate through to prostate cancer. In order to reduce the risks of prostate problems, it is important to know when you should start getting your prostate check by a professional, experienced urologist.
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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What Happens During A Prostate Exam
You don’t need to do anything specific to prepare for a DRE. Your provider will walk you through the steps of a DRE, but ask them questions if any parts of the exam are not clear.
A DRE can be done while you are standing or lying down. Your position will depend on factors like the layout of the exam room and any health conditions you may have.
If you’re going to stand during a DRE:
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A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.
While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.
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Prostate Exam Vs Colonoscopy: Whats The Difference
At first glance, it might seem that a prostate exam is similar to a colonoscopy. After all, both exams involve your rectal area. However, these two tests are quite different.
While a prostate exam involves feeling the prostate with a gloved finger, a colonoscopy examines the walls of your colon by inserting a flexible camera into your rectum. The prostate is not examined at all during this procedure unless your healthcare provider manually performs an exam.
A prostate exam is a fairly quick procedure performed in an office setting. A colonoscopy, on the other hand, is an outpatient procedure in the hospital that requires IV sedation.
Should I Have A Prostate Cancer Screening Test
Routine testing for prostate cancer in all men without symptoms is not recommended in New Zealand at present. Being tested for prostate cancer is your choice. Learning about the pros and cons of prostate testing can help you decide if it is right for you.
To help you decide if a prostate check is right for you, the Ministry of Health has developed the Kupe website. It will help you understand the risks, benefits and implications of prostate testing, so you can have an informed conversation with your doctor.
If you are unsure about whether you need to get tested for prostate cancer, contact your GP for a discussion on the risks and benefits of testing.
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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
The Position Of The Patient
Before explaining the procedure by which the rectal examination is carried out, we are going to tell you about the different positions you can take so that this test passes with maximum comfort, both for you and for the doctor. Normally, depending on your personal characteristics, the doctor will choose one or another position, although if necessary, he may also give you to choose the position in which you feel most comfortable. The three main positions the patient is usually in are:
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What Does The Psa Test Involve
The PSA test involves taking a blood sample and sending it to a laboratory for analysis. The results indicate:
- Normal levels: Most healthy adult males have PSA levels below 4 nanograms per milliliter .
- Borderline levels: PSA levels of 410 ng/ml are borderline. There is a 25% chance that cancer is present, and the person will usually need additional tests.
- High levels: If PSA levels are over 10 ng/ml, there is a 50% chance that the person has prostate cancer. The specialist will likely recommend more testing, including a prostate biopsy.
It is important to note that PSA levels can naturally vary from person to person. A person with high levels may not have prostate cancer. On the other hand, about 15% of people who test positive for prostate cancer after a biopsy have PSA levels below 4 ng/ml.
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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How Often Is A Prostate Exam Necessary
Your frequency of testing may be due to several factors, including your age, family history, and present health condition:
4049 Years of Age: Most urologists recommend men aged 40 and above to undergo a prostate exam if they have a family history or personal history of prostate cancer. Also, African-American men should talk to their doctor about how often to have these tests performed because they are at a heightened risk. The PSA test is the gold standard for prostate screening, and your doctor may also perform a digital rectal exam .
Your test results will further determine how often you may need a prostate exam. Generally, if your PSA result is under 2.5, you will likely only need the test every two years. On the other hand, if the result is higher, your doctor will probably recommend an annual prostate exam.
If the number is beginning to increase, your physician will probably ask you to return within a matter of months to have a follow-up test because an increasing PSA could indicate the presence of cancer cells. You may also need a biopsy.
50 Years and Above: Men with an average prostate cancer risk start getting a PSA exam at age 50. At this age, your provider may recommend an annual PSA and DRE. Your doctor will guide you regarding future PSA tests because the frequency may change as you age.
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 Jeffrey Spencer, MD, a Urologist at Finger Lakes Urology Institute for his expert opinion on prostate exams and prostate cancer screenings.
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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.
The Importance Of Prostate Health
Aside from skin cancer, prostate cancer is the most common cancer in men. According to the American Cancer Society, one in eight men will be diagnosed with prostate cancer, and one in 41 men will die from prostate cancer. More than 90 percent of men aged 80 or older have an enlarged prostate.
The prostate is a small, walnut-shaped gland that is a vital part of the male reproductive system. Located below the bladder and in front of the rectum, the prostate produces seminal fluid, which helps nourish and transport sperm.
There are several risk factors for prostate cancer, including age, family history and race. African American men are at a higher risk for prostate cancer than Caucasian men. Men with a father or brother diagnosed with prostate cancer also are at an increased risk.
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When To Start Pca Screening
Age
There is no consensus regarding the age at which to initiate PSA-testing . Most guidelines recommend that discussions about PSA screening start around ages 4555 with well-informed men in good health and a life expectancy of at least 1015 years. The core age group in the ERSPC trial started screening between ages 5569. The AUA guideline supports starting screening at age 55 based on the ERSPC trial and because of the risk of overdiagnosis in younger men, but also acknowledge that men at higher risk for PCa can start before 55.
A recent analysis of the U.S. PLCO trial specifically studied characteristics of 151 men who died from PCa within 13 years of follow-up and were randomized to the screening arm. The authors found that more than half of these men were never screened and they were also older at study start than the average participant .
Critical for balancing the benefits and harms of screening, particularly the risk of overdiagnosis, is the age to stop screeningwhich is covered in another article in this issue of TAU . For instance, stopping screening at age 70 can reduce overdiagnosis by 42% .
Risk factors
Albright and colleagues analyzed data from 600,000 men in the population-based SEER registry with information on family history and found that the relative risks of lethal PCa varied with the number of affected first-degree relatives .
What To Expect During The Study
This type of test can be done easily and quickly in your doctors office. In the first instance, a rectal examination is carried out to rule out anything abnormal, such as lumps and hard or soft areas. The urologist can also feel if the prostate is in a larger than the normal state.
If your doctor feels any abnormalities when performing the rectal exam, he or she will probably recommend a blood test. The blood test will indicate at what level the prostate cancer is, but it can also indicate other conditions, such as BPH or prostate infections. If you show abnormalities in your rectal exam and high levels in the blood test, the specialist may recommend additional tests such as:
- Transrectal ultrasound
- Prostate biopsy
- Magnetic Resonance Scan
Keep in mind that if any of the screening tests have unfavorable results, you should talk to your doctor about the next plan to perform. This will depend on your age, health status, and family history.
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Living With Prostate Cancer
As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.
Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.
You may find it beneficial to talk about the condition with your family, friends, a GP and other people with prostate cancer.
Financial support is also available if prostate cancer reduces your ability to work.
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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