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Overcoming Men's Objections
to a Prostate Examination
(from the American Foundation for Urologic Disease)
Although the prostate examination is quick and simple, many men resist having
this important test. Here are some
reasons men commonly mention for not
having a prostate checkup. Suggestions follow as to how you might answer.
1. Only old men have prostate problems.
Not true. Although prostate problems are most common after age 60, they
can affect men of any age, particularly those over 40.
2. I haven't had any symptoms.
Go anyway. Each year, more than 34,000 men die of prostate cancer.
Why? Because there are generally no symptoms in the earliest stages
when prostate cancer is most curable.
3. I feel embarrassed at the thought of the digital rectal examination.
So do most men. However, the prostate is an internal organ that cannot be
looked at directly. The way doctors routinely examine it is by gently sliding a
gloved, lubricated finger into the rectum, a process that takes only a minute.
Because women's reproductive organs are internal, women are more used
to internal examinations. Some men need extra encouragement to
overcome their embarrassment.
4. I heard that the examination is uncomfortable.
The examination, called the digital rectal examination, is simple and quick.
What are a few seconds of mild discomfort compared with a lifetime of
good health?
5. The last time I had a checkup, the doctor didn't check my prostate.
Because some men object to prostate examinations, not all physicians
routinely perform them. But no checkup of a man over 40 is complete
without it. Men should feel free to ask for a digital rectal examination as part
of a checkup.
6. I don't have time to go for a checkup.
Maybe you can help. Offer to make the appointment or even drive him to
the doctor's office. Emphasize that catching problems early, with the help of
regular checkups, takes less time from one's life than does waiting and
perhaps developing a serious illness.
7. If I do have a prostate problem, treating it may mean the end of my
sex life.
This is generally not the case. In many instances, treatment for prostate
disease, including prostate cancer, need not affect a man's sex life.
8. If something is wrong with my prostate, I don't want to know.
Prostate cancer is incurable.
Not true. Many prostate cancers are curable if detected early. Waiting
until symptoms appear only increases the odds of finding a prostate
problem when it is more advanced and less treatable. On the other hand,
symptoms can come from prostate problems other than cancer. So there's
no reason for men with prostate symptoms to be alarmed. There's every
reason to have a prostate examination.
The Prostate Examination
The doctor will first ask questions about medical history and any symptoms,
particularly any problems with urination. Next comes the physical examination.
Because the prostate lies in front of the rectum, the doctor can feel it through the
rectum by performing the digital rectal examination. This type of checkup allows
the doctor to estimate whether the prostate is enlarged or has lumps or other
areas that feel abnormal. While the examination may produce some discomfort,
it is quick and without risk. [For a line drawing how the examination is conducted, click here.]
Some doctors are also beginning to perform a blood test called the PSA
(prostate specific antigen) test to help determine whether prostate cancer might
be present. Other physicians use this test only as an additional diagnostic tool
when the digital rectal examination indicates a possible prostate problem. [For information on the PSA test, click here.]
How the Digital Rectal Examination Helps Detect Prostate Disease
If the results of the checkup suggest a bothersome or serious prostate problem,
the doctor may recommend seeing a urologist. A urologist is a doctor who
specializes in diseases of the urinary tract and male reproductive system. The
urologist may perform other tests or diagnostic procedures to better determine
the nature of the problem. The three principal prostate diseases are described in
more detail below.
Prostate Cancer
Each year more than 130,000 new cases of prostate cancer are found in the U.S.
More than 34,000 men will die from the disease this year. Nearly one of every 10
men will develop this form of cancer. It is second only to lung cancer as the
leading cause of cancer death in men. The chance of developing prostate cancer
goes up with age.
Prostate Cancer is the Most Common Cancer
In U.S. Men
and Second Leading Cause
Of Cancer Deaths
Prostate cancer is a malignant tumor that begins most often in the outer part of
the prostate. As the tumor grows, it may spread to the inner part of the prostate
where the urethra, the tube that carries urine, is located. The cancer must grow
fairly large before it presses on the urethra and causes trouble with urination.
That's why it's a good idea to have regular prostate checkups even when there
are no symptoms.
In the early stages, most prostate cancer is curable. With early treatment, the
percentage of men who stay alive longer than 10 years is just about the same as
for men who have never had prostate cancer. By the time a prostate cancer
causes symptoms, however, it may not respond as well to treatment. If allowed to
grow without treatment, some prostate cancers may spread to other organs. The
result may be disability and sometimes even death.
Diagnosis generally involves a series of steps: First, the doctor will ask a number
of questions. Next comes the digital rectal examination. If the doctor suspects
that a cancer is present, he may recommend additional tests to confirm the
diagnosis or indicate the extent of the cancer's growth. One such test is a biopsy
in which the urologist obtains a small sample of the prostate for examination.
If the diagnosis of prostate cancer is made, the doctor will often advise that
treatment be undertaken. Surgery, radiation therapy, or medications may be
discussed, depending on the extent of the cancer. The doctor will advise on the
treatments most appropriate for a particular patient. Because of their slow
growth, some small, early-stage prostate cancers may not require treatment,
especially in patients who are very old or very ill.
Enlarged Prostate
After men reach age 40, their prostates often begin to enlarge. This condition is
known as benign prostatic hyperplasia, or just "BPH." The majority of men
eventually develop enlarged prostates. Many, but not all, of these men will have
some trouble with urination.
It is important to note that BPH is not cancer nor does it lead to cancer.
However, a man can have both BPH and prostate cancer at the same
time.
BPH usually affects the innermost part of the prostate first. The enlargement often
squeezes the urethra where it runs through the prostate. This pressure
sometimes causes trouble with urination. When symptoms of BPH are
bothersome or a serious blockage causes a kidney problem or other
complication, treatment may be needed.
In this case, the patient and doctor should discuss whether treatment is
necessary and what treatments are available. Surgery is the treatment choice
most recommended. However, other forms of therapy, including medication, are
becoming available. All the options should be discussed with the doctor before
going ahead.
Prostatitis
The word prostatitis refers to three different types of inflammation of the prostate:
 acute (sudden and severe) infectious prostatitis -- usually marked by
chills and fever
chronic (long-lasting) infectious prostatitis
noninfectious prostatitis
Symptoms of prostatitis vary and may include trouble urinating; pain in the lower
back, joints, muscles, or the area between the scrotum and the anus; or painful
ejaculation. Unlike other prostate diseases, prostatitis affects younger men most
often.
Acute and chronic infectious prostatitis are caused by bacteria. These infections
need to be treated with antibiotics. In order to prescribe the correct treatment, the
doctor will often test the urine (a urinalysis) and prostate fluid for signs of
infection.
Because bacteria do not cause noninfectious prostatitis, antibiotics are not
effective. Muscle relaxants or other treatments may be recommended.
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