Prostate Exam
 

The doc put his Dr. Thickfinger gloves on and I politely told him no way. Check my PSA level. Got blood work done and PSA is fine, however I am noticing a reduced "water pressure" when I pee. Should I have allowed Dr. Thickfinger examine the prostrate? Not sure, but something may be going on down there as I pee more than usual and the water pressure is lower than usual.

I think many docs have abandoned the 'finger' exam because of too many false positives and false negatives. Though far from perfect, the PSA test seems the most reliable. Assuming you're a male (j/k), by mid-life odds are you will experience the symptoms you've mentioned. You can read about Benign Prostatic Hyperplasia (BPH) at your leisure. Lastly, neither am I a doctor nor have I ever played one onstage. I have, however, had finger exams and PSA tests.

Autocorrect should be programmed to stop correcting "prostate" to "prostrate" when it detects that a man over 50 is typing.

The DRE, Digital Rectal Exam can be a very beneficial part of a Wellness Exam. Feeling something abnormal might indicate an issue exists with further testing being advisable just as a High or Low PSA are not good indicators of PCa(Prostate Cancer) being present but something might be happening.

I had no flow or pain issues when urinating, had an elevated PSA and my PCP felt something hard during her DRE. What she felt was later confirmed through a biopsy as been a Gleason10.

After my father died from prostate cancer a few years ago, now I wouldn't object to any test the doctor recommended.

Besides, after years in the military, amateur boxing and working in health care, I'd pretty much lost all my shy bones by the time I was 20. For some reason every full and part time job I applied for years ago required a prostate exam despite the low risk for younger men. Covering their insurance bases, I suppose.

I never noticed anything unusual while urinating until this year, but I've begun to do that pee-pause-pee-pause-pee-some-more thing. So while I'm recover from my recent thyroid surgery I'll schedule an appointment to check the prostate. Hadn't had any prostate exam in more than 20 years. I'm 61 now, way overdue.

Prostate cancer is generally considered to be a bit lower in risk for metastasizing but there are no guarantees. Dad spent several years with catheters, even while commuting to work by train in his 70s. I can't imagine how uncomfortable that must have been. And after about 10 years of having it under control it flared up and metastasized, killing him in only a month.

Same reason I wanted to have my thyroid tumor taken care of pronto after it was diagnosed earlier this year. The risk for metastasis is low with thyroid cancer, but I didn't want to take any chances after my dad's experience. Besides, the thyroid was no longer functional and it was so swollen it was interfering with my esophagus and trachea, so it was painful to swallow and occasionally worsened my asthma constriction. It's been less than a week since surgery and it's already easier to swallow.

Yep. The digital exam is a must. They can detect lumps and the like that are a good indication that something is amiss.

I had a female doc do it once. I think she was more embarrassed than I. While she was digging around, she said:

"At least my finger is smaller."

Ah, but those fingernails!

I hear you. I have had DREs by several Docs both male and female, no problems. Colonoscopies are fun, the last one had good results. I have lain in hospital totally helpless and at the mercy of seemingly dozens of good people coming and going and moving me about in my morphine induced haze. The Head Nurse even let me go home, only on the condition of course, that I could produce X milliliters of urine on my own:eek:

I have an advertising degree. And, I also figure if the doc wants to do that it can be only for two reasons. One s/he enjoys it. Or, two it is a good idea for patient care. I've always gone with number two since I have had different doctors perform the same exam.

I have also been through the medications and operation. I couldn't be happier with the results of the Green Light Laser.

My primary care doc did the finger test and told me my prostate didn't "feel right" and referred me to a urologist. The uro doc did more tests, a prostate MRI and a biopsy. Long story short — my PSA never got above 2.6 yet my prostate was loaded with cancer. He said I had 2 months to decide on surgery or radiation plus chemo because the cancer was growing rapidly and would begin to spread to other parts of the body via the lymph system. It took my wife and I two seconds to say, "SURGERY"!!
The surgery was three years ago next month and I have had NO problems.

Don't be a baby. Let the doc do the finger test.

I agree. The PSA test is not an accurate predictor of prostate cancer. Neither is a DRE but it (or DRE and PSA) can raise alarms. Keep in mind that PSA rises with the size of the prostate so BPH can be expected to raise PSA. The Mayo Clinic says men over 70 with no other risk factors for PCa should probably not even be tested for PSA.

This stuff is all a bit of a crap shoot.

The only definitive diagnosis of prostate cancer is through biopsy. The digital rectal exam can reveal an enlarged prostate, which is not necessarily an indication of cancer. Elevated PSA can only be considered as a screening tool to suggest further work-up, e.g. biopsy.

If you are having problems emptying your bladder, the digital exam is a quick, minimally invasive test that can reveal an enlarged prostate obstructing the urethra, which is not necessarily cancerous. Non-invasive bladder ultrasound (much like the ultrasounds women get when pregnant) can show whether your bladder fully empties when you void, which can be an indication for further treatment. Treatment for prostatic hypertrophy can either be medical or surgical. Surgical treatment has the advantage of obtaining tissue that can be tested for cancer cells.

That said, prostate cancers tend to be quite slow growing, and there is evidence accumulating that hasty treatment of a diagnosed prostate cancer is not always the best option, as there can be considerable side-effects. Many men die of natural causes long before their prostate cancer becomes a significant risk to their health, so passive monitoring is often now considered to be an appropriate response to finding an enlarged prostate. Nor is an enlarged prostate the only possible explanation for voiding difficulties. If you feel this is affecting your quality of life, seek a referral to a urologist.

(writing as a retired RN who has seen my share of urology patients)

So did you think your doctor is some kind of pervert? What would you have done had you found a lump on a testicle, simply ignored it for fear the doc might touch your privates? Give me a break!!

The purpose of DRE isn't just to detect an enlarged prostate...it's to evaluate for lumps or nodules that might be prostate cancer. For a 50 year-old to NOT do everything possible to diagnose prostate cancer as early as possible just to avoid having a doctor do a rectal exam is dumb and unnecessarily risky.

Risks of treating prostate cancer include impotence and incontinence, among other things. Prostate cancer is often slow-growing enough that men can avoid those risks by monitoring the status of their prostate. As you note, an enlarged without lumps is not considered to be a cancer risk. A lumpy prostate, enlarged or not, is a concern, but whether that makes it enough of a concern for further intervention is something only you can decide, in consultation with your doctor. If your prostate shows changes, new lumps, increased size, etc., that elevates the concern level. If you have voiding difficulty, urinary retention, etc., that impinges on your quality of life through incontinence, bladder infections, etc. then some sort of intervention seems prudent to consider.

Not helpful tough guy.

Everyone handles medical procedures differently. I think the OP knows he made a mistake and can now go back and let the doc do what he has to. Aging isn't easy!

After 40 years as a surgeon and having done 10's of thousands of DRE's, I have a reasonably clear concept of the diagnosis and treatment. It's an evolving paradigm but not a decision-making process that should be derived from the internet. Second opinions (from an actual urolgist) are highly recommended.

No, not a tough guy, Giacomo dear. Please don't tell me about aging:-). I'm 78 and was diagnosed with prostate cancer, low-intermediate stage with a trace of Gleason 5, three years ago and had all the bells and whistles of 25 doses of radiation (IMRT) followed by radioactive seeds( brachytherapy). I had had PSA and DRE annually for many years and saw my PSA gradually increase from around 1.2 to 4.8, plus a nodule detected by the DRE, but no other symptoms. Now it is 0.1. It's people like the OP who make men nervous about having the DRE or nothing at all, too often resulting in unnecessary deaths from the metastasized cancer. I lost two colleagues because of their resistance to the tests. As someone mentioned, a single PSA number might not be indicative of cancer, but an upward trend over time can be.

Both the General Practitioner Finger exam and the PSA are screening exams, with both false positives and false negatives.

If, however, you're actually feeling changes (urine flow, frequency, etc), then perhaps ask for a urology consult and ultrasound, and a biopsy if indicated.

I'm surprised she didn't cut the fingernails.

I doubt surgeons or surgical nurses are allowed to have long nails.

Burying one's head in the sand is not a good medical choice. The DRE isn't that big of a deal but can be totally avoided if one wants. My suggestion would be to have a 3TmpMRI performed and if something (possible cancer) becomes apparent then following up with the MRI Guided biopsy is MUCH MORE accurate than a TRUS biopsy.

https://grandroundsinurology.com/poi...-mapping-part/

A more complete biopsy than a MRI Guided would be ---

https://grandroundsinurology.com/lepor-stone-part-2/

IMO, yes, go with a finger wave. If an enlarged prostate, or lumps, your Doc is likely to get a good first indicator...and if it significantly increases your discomfort---another indicator to look further.

((prostate cancer survivor...+16yrs))

Not sure if your reply was a :innocent: , the 3TmpMRI is now considered FAR SUPERIOR to the antiquated TRUS and covered by most insurances. Some require a TRUS first but the issue there is that a TRUS biopsy samples a very little segment of the prostate and many times totally misses the cancer.

If the urologist will not prescribe a 3TmpMRI, bike quickly to another doctor who will. It could mean the difference between death or life.