The Prostate Exam

What is the prostate?

The prostate—a gland in men—plays an important role in the male reproductive system. It wraps around the urethra, which is the tube that carries urine away from the bladder and out of the body (the urethra also carries semen, the fluid containing sperm, out of the body during ejaculation), and secretes a milky alkaline fluid that constitutes approximately 30% of the volume of semen. During ejaculation, the smooth muscles of the prostate gland contract to force semen out of the body. Though in young men the prostate gland is about the size of a walnut, it slowly increases in size with age. If it grows too large, serious health problems may occur.

There are a variety of common prostate-related health conditions, one of which is an enlarged prostate. Those suffering from an enlarged prostate (also referred to as benign prostatic hyperplasia) may experience frequent urination, strained urination, a weak or slow urinary stream, dribbling of urine, or constantly waking up throughout the night to urinate. Enlarged prostate (BPH) is common problem in older men. Another common prostate disease is prostatitis. Prostatitis involves inflammation of the prostate and/or the surrounding area. There are several different types of prostatitis with symptoms ranging from mild to severe. If left untreated, prostatitis can greatly impact a man’s quality of life. The last (and most serious) type of prostate disease is prostate cancer. Prostate cancer is the most common type of cancer in men (after skin cancer). Symptoms associated with prostate cancer include difficulty urinating or holding in urine, erectile dysfunction, blood in the urine, pain in the spine, hips, ribs, or other bones, weakness or numbness in the legs or feet, and loss of bladder or bowel control.

 

 

What is a prostate exam?

Doctors administer prostate examinations to help diagnose prostate-related conditions like enlarged prostate (BPH), prostatitis, and prostate cancer. A prostate examination is designed to find early indicators of prostate disease. Doctors utilize two methods of prostate examination: digital rectal exams and prostate-specific antigen (PSA) testing.

The PSA Test

Prostate-specific antigen (PSA) is a protein produced by the prostate gland. PSA tests measure the amount of PSA present in a man’s blood. To perform PSA tests, patients’ blood samples are sent to a laboratory for analysis. Test results are typically reported as nanograms of PSA per milliliter (ng/mL) of blood. Elevated blood levels of PSA may indicate certain prostate diseases, including prostate cancer.

Originally, doctors utilized PSA testing to monitor the progression of prostate cancer in men who had already been diagnosed with the disease; but in 1994, the FDA approved the use of PSA testing to check asymptomatic men for prostate cancer. Over the past decade, PSA testing has become integral to the screening process for prostate cancer.

Men who receive a PSA test result indicating abnormally high blood levels of PSA do not always have cancer. There are a number of benign conditions that cause a man to have high PSA levels:

·      Prostatitis (inflammation of the prostate and surrounding area)

·      Urinary tract infection

·      Benign prostatic hyperplasia (enlargement of the prostate)

·      Injury

·      Treatments such as prostate biopsies (tissue samples) or cystoscopies (procedures used to see the inside the urethra and bladder).

It is also important to keep in mind that PSA levels are influenced by other factors such as old age or pre-existing prostate size.

Although PSA screening has its benefits, it also carries risks. The Urology Care Foundation created the following list of possible benefits and risks associated with PSA testing.

Possible benefits of having a PSA test:

·      A normal PSA test may eliminate doubt.

·      A PSA test may find detect cancer before it has spread.

·      Early treatment of prostate cancer may slow the progression of the disease.

·      Early treatment of prostate cancer may save lives.

Possible risks of having a PSA test:

·      Men with prostate cancer may receive “false negative” test results.

·      “False positive” test results may cause unnecessary stress and worry.

·      “False positive” test results may lead to an unwarranted prostate biopsy.

The PSA test is not perfect, but does provide important information. When used correctly, it can help diagnose, assess the risk of, and monitor prostate disease.

 

 

The Digital Rectal Exam

The digital rectal exam is a relatively simple test used to check prostate health. During a rectal exam, a doctor inserts a gloved, lubricated finger into the rectum and feels the prostate for hard, lumpy or abnormal areas. The exam should take no longer than a few minutes to complete. Though it is normal to feel slight pressure, men should not experience pain or physical discomfort during the exam (if it hurts, tell the doctor immediately!). This procedure allows doctors to examine the size, shape, and texture of the prostate gland. Similar to PSA testing, digital rectal exams are primarily used to screen for prostate cancer. Unfortunately, most cancers cannot be felt during a rectal exam. For this reason, many consider digital rectal exams to be less effective than PSA tests. With that being said, it is important to remember PSA test results are often incorrect. Digital rectal exams can detect indicators of prostate disease in men who receive “false negative” PSA test results. Nonetheless, the use of digital rectal exams for cancer screening purposes is controversial. Medical institutions disagree on when men should begin routine screenings. Many researchers question if digital rectal exams should be used at all.

 

 

Should I get tested?

Though prostate examinations may find prostate cancer early, research has yet to prove that the benefits of getting tested outweigh the risks. Existing tests cannot differentiate between slow-growing and fast-growing prostate cancer; consequently men with slow-growing cancers sometimes receive unnecessary treatment. Two recent studies—one American, one European—call into question the necessity of PSA tests and digital rectal exams. Researchers were unable to prove prostate cancer screenings save lives. In light of these findings, medical institutions are now hesitant to say all men should get tested for prostate cancer.

Nevertheless, the American Cancer Society recommends that men take certain precautions:

·      Men aged 50 or older should consult a doctor about getting tested.

·      Men should discuss the pros and cons of testing before deciding whether or not to get a prostate exam.

·      African American men should begin discussing testing earlier, at age 45.

·      Men that have a father or brother who had prostate cancer before age 65 should also consider getting tested earlier, at age 45.

·      Men that decide to be tested should have the PSA blood test with or without a rectal exam.

Getting tested is a personal choice that should be evaluated case-by-case. Make an informed decision by researching the benefits and risks of prostate examinations. Speak to a doctor about your individual risk for prostate cancer, including your personal and family health history.

 

 

References

1. "Digital Rectal Exam (DRE)." Cancer.Net. N.p., 26 Feb. 2014. Web. 12 Mar. 2015.

<http://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and....

2. "Prostate Problems." National Institute on Aging. N.p., 27 Jan. 2015. Web. 12 Mar. 2015.

<http://www.nia.nih.gov/health/publication/prostate-problems>.

3. "Prostate-Specific Antigen (PSA) Test." National Cancer Institute. N.p., 24 July 2012. Web. 11

Mar. 2015. <http://www.cancer.gov/cancertopics/types/prostate/psa-fact-sheet>.

4. "Revised Prostate Cancer Screening Guidelines: What Has-and Hasn't-Changed." Revised

Prostate Cancer Screening Guidelines: What Has-and Hasn't-Changed. N.p., 3 Mar. 2010. Web. 12 Mar. 2015. <http://www.cancer.org/cancer/news/revised-prostate-cancer-screening-guid....

5. "What Men Should Know About Prostate Screening." Urology Care Foundation. N.p., 2013.

Web. 12 Mar. 2015. <http://www.urologyhealth.org/_media/_pdf/5-13%20What%20Men%20Should%20Kn....