Don’t Be Afraid of the Prostate Exam

If you’re a man age 50 or older and haven’t had a prostate exam, you should talk to your doctor about scheduling an appointment.

Many men put off getting a prostate exam, either because they think they’re not old enough to have it or because they’re afraid to have one. But there’s no reason you should be afraid of a prostate exam, and educating yourself about the exam can help you prepare for it.

The prostate is a walnut-sized gland, located near the bladder, that helps produce seminal fluid. A prostate exam helps your doctor diagnose an enlarged or inflamed prostate.

The exam can also help them diagnose prostate cancer, which — other than skin cancer — is the most common form of cancer among American men. A prostate exam usually involves a digital rectal exam (DRE) and a blood test for prostate-specific antigens (PSA test).

All men should discuss prostate cancer screening with their doctor, once they reach the age of 50. The American Cancer Society advises men at higher risk — especially, African Americans or those with first-degree relatives with prostate cancer before age 65 — to begin testing at age 40 or 45.

The DRE: quick and simple

The most common way for doctors to check on the health of your prostate is with a DRE. Some doctors do the exam as part of a routine checkup.

You will be relieved to know that the DRE is a quick and simple procedure, during which you will bend at the waist while standing or lie on your side with your knees bent toward your chest. Your doctor will lubricate a gloved finger and gently place it inside your rectum. They’ll press one hand on your prostate, and their other hand will feel your pelvic area. It should only take a few moments.

You may experience momentary discomfort. You also may feel the urge to urinate, especially if your prostate is enlarged or inflamed. In general, a DRE has no risks.

Most men can return to their usual activities, immediately after having a DRE. There may be a small amount of bleeding from the rectum afterward, if there had previously been hemorrhoids or anal fissures. If your doctor finds any areas of concern during the DRE, he will ask for additional tests to examine them closely.

The PSA: It’s more complicated.

An additional test for prostate cancer involves testing your blood for PSA levels. PSA is a protein that helps liquefy semen. Some forms of prostate cancer can lower your PSA, although there may be other reasons why your PSA levels are off.

To guarantee an accurate test, a patient must not have a urine infection, must not have ejaculated for 48 hours before the test, must not have exercised heavily in the previous two days nor had a prostate biopsy within the last six weeks.

You may decide to do the test every one or two years. If the PSA level is high, you’re likely to be asked to have more tests done. These might include an examination of the prostate gland and a prostate biopsy. This will depend on your age, family history, ethnicity, body weight and previous medical history.

You will need to consult your doctor about the pros and cons of having a PSA test done. This test may result in false positives and false negatives for prostate cancer. It could lead to additional testing and treatment and may not be recommended for everyone.

Diagnosis and treatment

If you do get a prostate cancer diagnosis, there are many options for treatment. One such treatment now in place involves using noninvasive high-intensity focused ultrasound (HIFU) beams to nonsurgically destroy prostate tumors.

“The goal of focal HIFU is to target and destroy only the significant cancer lesion, thereby preserving the delicate nerves around the prostate, thus protecting both continence and potency,” says Inderbir Singh Gill, MD, executive director of USC Urology at Keck Medicine of USC, chair and distinguished professor of urology at the Keck School of Medicine of USC and associate dean for clinical innovation. “This is a noninvasive, nonsurgical, outpatient procedure that does not involve any radiation. There is no blood loss, the recovery is quick, and typically, the patient is back on his feet and discharged home the same day.”

The five-year survival rate, after early prostate cancer diagnosis, is nearly 100%, and treatments for prostate cancer are improving every year.

However, the diagnosis of prostate cancer depends on you having the test done in the first place. So, you should visit your doctor armed with the knowledge that having a prostate test done is no big deal. After all, when it comes to your health, you shouldn’t let fear stand in your way.

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