Prostate Exam

[Guest ncm2169]

There seems to be an abundance of topics covering this part of male anatomy, so one more might be useful. :*

 

I have had dozens of "prostate exams" where the Doc dons a glove and lubes up with KY Jelly and, with me in a doggy position on the "examining table", proceeds to "examine my prostate." I would swear that none of those "exams" took more than about seven seconds. In each case, The Doc pronounced my prostate was fine, and the accompanying PSA blood test confirmed his diagnosis.

 

Here's the deal: I have been both fingered and fucked when my prostate has been seriously stimulated, and I have used toys to achieve the same result.

 

Can anyone enlighten me as to how a Doc can make a diagnosis without really stimulating my prostate gland?

[doctordoctor]

hey....gotta agree with you....

 

the one and only digital prostate exam I got was a one- or two-second affair with no pain or pleasure....just a very brief brushing/rubbing back there...he said fine and that was it....it just didn't feel like he even got in to the prostate.....

 

'bout time for another physical, actually....will see how he does this time and question whether her really checked....

 

is this normal?.....should I've felt more during the check??

 

thanks

[edjames]

A digital prostate exam does not involve stimulating your prostate. The doctor is checking for lumps or growths on the prostate which would indicate tumors or, God forbid, cancer. He is also looking for unusual size, which may indicate a problem and further tests.

 

Here's some advice my doctor gave me recently. Never, never let them do a PSA blood test after you've gotten a digital rectal exam. The digital exam may, in fact, stimulate the prostate and the resulting blood test may be higher than normal. Have them do the PSA blood test on a subsequent visit.

 

I've also been told that a digital exam is only one indicator that something may be wrong and the doctor can only feel one side of the prostate. It's always good to have a PSA test.

 

ED

[KMEM]

My doc also said to not get a PSA after a DRE but one does not have to go back for the PSA, just get the blood drawn before the DRE. We spend too much time doing things we don't want to do as it is, meaning doing what others want or require, i.e. your doctor, your lawyer, your CPA, the IRS, other government agencies, etc., etc.

 

Best regards,

KMEM

[poiuyt]

All the PSA test really measures is how large your prostate is. In the old days, a high PSA was a pretty good indicator of cancer, but now not so much, since they usually catch cancers early. If they use it at all, they're looking for a suddenly increasing PSA level. Most prostate cancers are caught by DRE.

 

The biggest problem these days is overdiagnosis. Prostate cancers are common and grow slowly, and there's a good chance it won't be a problem for many men. After any treatment (radiation, surgery), there's a slight chance you'll be seriously incontinent, and a good chance you'll be impotent. On the other hand, if you ignore it and it spreads, usually to the bones, you face a painful, ghastly death. At that point, the main treatment is chemical castration, since testosterone feeds the cancer. This can let you live many years, but there are side effects (your beard falls out, you grow tits, you lose any interest in sex, etc).

 

Isn't it fun growing old?

[Guest]

>Here's some advice my doctor gave me recently. Never, never

>let them do a PSA blood test after you've gotten a digital

>rectal exam. The digital exam may, in fact, stimulate the

>prostate and the resulting blood test may be higher than

>normal. Have them do the PSA blood test on a subsequent

>visit.

>

It's been fairly well-known for the last 15 years that the Digital Rectal Exam (DRE) has no clinically significant effect on PSA levels:

http://jama.ama-assn.org/cgi/content/abstract/267/16/2227

If it were to increase levels (such as the way a prostate biopsy increases PSA levels), you would want to wait 4 weeks for the level to come to baseline. It has been many, many years since I heard any doctor advise waiting for a PSA test after a DRE.

When doing a DRE, the examining doctor checks for prostate contour, volume, consistency, presence/absence of tenderness, symmetry, and, most importantly, presence/absence of nodules. A nodule is highly suggestive of cancer and should be biopsied irrespective of PSA. A large prostate without a nodule will often have a high PSA, with a high subset of Free PSA (indicating a noncancerous origin). A tender prostate generally indicates infection; this can also lead to a quite high PSA which will come down substantially 2 months later.

A large prostate with obstruction indicates that a medication to shrink the prostate, such as Proscar or Avodart, is likely to prevent the need for surgery.

The wisdom (or lack thereof) of general screening for prostate cancer in asymptomatic men has been discussed in prior strings.

[CT Dick]

There is also the effect of orgasm on PSA levels. According to a report in "The World Journal of Urology," PSA levels do increase after an orgasm.

 

http://www.springerlink.com/content/w075337283783456/

 

The word from a prostate cancer support group is to abstain at least 24 hours before the blood test.

 

Dick

[KMEM]

Am I writing with invisible print? Regardless of whether your doc thinks the DRE affects the PSA or not, the simple solution is to take the blood before the DRE.

 

There is still a lot of unknowns about prostate cancer. I agree the PSA itself is not a good indicator. A rising PSA is a reason for suspicion. I do not agree that most cancers are found by DRE. Just another indicator.

 

Biopsy is also not fool proof. Just because the biopsy doesn't find cancer doesn't mean it isn't there.

 

As with most things regarding health, regular check-ups and following up any suspicious findings are the key.

 

Best regards,

KMEM

[Guest icon513]

My doctor asks me to abstain from sex the night before a PSA test, saying that recent orgasm can raise the levels.

[Guest]

>Am I writing with invisible print? Regardless of whether

>your doc thinks the DRE affects the PSA or not, the simple

>solution is to take the blood before the DRE.

>

It's always better to have a doctor who knows something (because he's read the medical literature or attended medical conferences), than to have a doctor who thinks something because of something he seems to have remembered from 20 years ago in medical school.

 

>There is still a lot of unknowns about prostate cancer. I

>agree the PSA itself is not a good indicator. A rising PSA is

>a reason for suspicion. I do not agree that most cancers are

>found by DRE. Just another indicator.

>

I don't think anyone believes most cancers are found by DRE. Fewer than 1/4 are (~20%).

[KMEM]

>>Am I writing with invisible print? Regardless of

>whether

>>your doc thinks the DRE affects the PSA or not, the

>simple

>>solution is to take the blood before the DRE.

>>

>It's always better to have a doctor who knows something

>(because he's read the medical literature or attended medical

>conferences), than to have a doctor who thinks

>something because of something he seems to have remembered

>from 20 years ago in medical school.

>

>>There is still a lot of unknowns about prostate cancer.

>I

>>agree the PSA itself is not a good indicator. A rising

>PSA is

>>a reason for suspicion. I do not agree that most cancers

>are

>>found by DRE. Just another indicator.

>>

>I don't think anyone believes most cancers are found by DRE.

>Fewer than 1/4 are (~20%).

>

Unicorn,

 

Apparently Poiuyt believes the DRE finds most prostate cancer; he makes that statement in #4 above.

 

Some times I think medical science should be called medical art. It is amazing how often studies of various types are later proven wrong or not the point. I think one should choose the best doctor one can find that suits them; then use your own sensibilities and research to see if what they say makes sense.

 

Regardless of what one would hope we all are not going to get cutting edge treatment for every thing that ails us. There are any number of factors that could enter into such a situation including distance from home to reach the treatment, cost of treatment, cost of being at the treatment site, knowing no one there to help you physically and mentally get through the treatment, the attitude of various members of the treatment facilities, etc. Some of these are objective and some subjective but all can be only too real for the patient.

 

Recently someone I knew had a child with leukemia. I and others felt strongly that St. Jude's Hospital in Memphis gave an excellent chance to cure the child. The family chose to stay in Atlanta and do the treatment there for one or more of the reasons stated above. After stating my reasoning, there was nothing more for me to say other than I will be thinking of you during this time.

 

Best regards,

KMEM