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A comprehensive guide endorsed by medical professionals for identifying symptoms of prostate cancer and other conditions
A digital rectal exam (DRE) stands as one of the primary techniques employed by physicians to assess the prostate for potential cancer and other ailments. This involves a brief insertion of a finger into the rectum by the physician to detect any abnormalities that could signify prostate cancer, benign prostate hyperplasia (enlarged prostate), or prostatitis (inflamed prostate, typically due to infection). It is not recommended for individuals to attempt self-examinations due to the specialized training required for accurate assessment. However, for those interested in self-examination, this guide outlines the methods utilized by healthcare professionals, along with indicators that may necessitate a professional prostate examination or screening.
Essential Information
- Assume a lying position on your side with knees drawn towards your chest. Proceed to wear a sterile latex glove, lubricate the index finger, and gently insert it into the rectum.
- Identify the prostate against the rectal wall towards the abdomen. Search for any tenderness, irregularities, firmness, or inflammation that could indicate an issue.
- Seek a professional examination to confirm any abnormalities. Your healthcare provider will likely conduct a DRE and/or a prostate-specific antigen (PSA) blood test.
Procedure
Guide to Self-Prostate Examination at Home
Consider having your physician conduct the examination for precision and safety. While it might appear straightforward, performing prostate examinations necessitates proper technique and the ability to interpret sensations accurately. Unless you possess medical expertise, you're unlikely to accurately assess your own prostate.
- Self-examination may result in complications such as bleeding from nail punctures or cysts. This could lead to infection or other issues, necessitating a visit to your physician regardless.
- Furthermore, if your self-examination yields abnormal results and you seek advice from your physician, they will likely repeat the examination to confirm the findings.
Undress and lie on your left side with your knees drawn towards your chest. If you opt to perform self-examination at home, assuming this position offers the easiest access to your rectum for either yourself or a partner. This mirrors the position a physician would have you adopt for a scheduled prostate screening (or any other rectal examination).
- Alternatively, stand leaning forward with your hips flexed if lying down is uncomfortable.
- No preparation is necessary before the examination. Some individuals believe they must have or delay a bowel movement beforehand, but this is unnecessary.
Examine the area surrounding your anus for any skin conditions. Utilize a hand mirror or request assistance from a partner to inspect for external hemorrhoids, anal fissures, skin tags, warts, or discharge. These conditions can exacerbate discomfort during the self-examination or even cause pain, and improper examination may result in puncturing or infecting these growths.
- Note: If any of these conditions are encountered, it is advisable to halt the self-examination and schedule a digital rectal examination (DRE) with a medical professional.
- Trim your fingernails closely prior to washing your hands and donning the glove if you have long or unkempt nails. Even with the latex glove, accidental scraping or puncturing of the area can occur.
Apply lubrication to the index finger of the glove. Ensure thorough coverage of the index finger with a generous amount of lubricant, extending from the tip to the knuckle. Using a lubricant such as Vaseline or KY Jelly facilitates smoother and less stressful penetration into the rectum.
Palm the rectal walls to detect any irregularities. Delicately insert your index finger into the rectum and maneuver it in a circular motion to discern any anomalies such as lumps or protrusions that may signify cancerous growths, tumors, or cysts along the rectal walls. Rotate your finger clockwise and counterclockwise from the 6 o'clock to 12 o'clock positions.
- In the absence of abnormalities, the rectal walls should exhibit a uniform, smooth texture.
- Apply gentle pressure; although discomfort may be experienced, severe pain should not occur during insertion.
Probe the rectal wall in the direction of your navel to locate your prostate. Your prostate is positioned above or anterior to this segment of the rectal wall. Deviations encountered while palpating toward the prostate may include areas that are firm, irregular, non-smooth, enlarged, and/or sensitive.
- An optimal prostate is roughly the size of a walnut and possesses a pliable, soft texture with a subtle indentation down the center dividing it into left and right lobes.
- Nodules or unevenly sized lobes on the prostate may indicate the presence of cancer or other issues.
Withdraw your finger gradually and gently. In a clinical environment, the entire examination typically lasts around 10 seconds. After palpating the prostate for a brief period to assess for abnormalities, prolonging the examination is unnecessary and may cause additional discomfort or irritation. Discard the glove and promptly wash your hands again.
Arrange a follow-up consultation or examination with your physician. Schedule an appointment with your doctor for further evaluation and discussion. If abnormalities were detected during the self-examination, promptly seek medical attention. Inform the physician that you conducted a self-examination if less than two days have elapsed, as this could affect subsequent test results, potentially elevating PSA levels.
Guidelines for Prostate Screening
Arrange a prostate screening appointment with your physician if you're aged 50 or above. According to the American Cancer Society, men aged 50 and older should undergo annual prostate screenings. However, certain factors and conditions may necessitate screenings at an earlier age, including:
- At age 40 for men with more than one first-degree relative (son, brother, or father) diagnosed with prostate cancer before age 65.
- At age 45 for men with a single first-degree relative diagnosed with prostate cancer before age 65.
- At age 45 for African American men due to their heightened risk of prostate cancer.
Seek an examination if you experience any urinary symptoms attributed to the prostate, such as blood in the urine. Prostate-related issues can impact the functioning of the bladder, urethra, and penis due to the prostate's proximity to these systems. Symptoms of prostate problems may include:
- Slow or weak urine flow
- Difficulty urinating
- Nocturia (frequent urination at night)
- Burning sensation during urination
- Hematuria (blood in the urine)
- Erectile dysfunction
- Painful ejaculation
- Lower back pain
Seek prompt medical attention if you experience any urinary symptoms. A digital rectal examination (DRE) alone may not suffice to diagnose various conditions responsible for your symptoms. Your physician may employ additional tests to assess the prostate's health, such as:
- Transrectal ultrasound (TRUS) to examine potential abnormalities within the rectum.
- Biopsy to confirm or rule out the presence of cancer.
Request a prostate-specific antigen (PSA) test during your medical consultation. Your physician will order a laboratory blood test to measure your PSA levels (a specific protein found in the prostate) if you exhibit prostate abnormalities or urinary symptoms. Generally, a PSA level of 4 ng/mL or lower is deemed normal.
- PSA levels may yield false positive or false negative outcomes. The United States Preventive Services Task Force advises against relying solely on PSA screenings due to these risks.
- Elevated PSA levels may be triggered by factors such as recent ejaculation, prostate infection, digital rectal examination (DRE), or bicycling (due to pressure on the prostate). Individuals without prostate symptoms and elevated PSA levels may necessitate repeat testing after two days.
- Persistent elevated PSA levels may prompt further evaluation with a DRE and/or prostate biopsy (a procedure involving the insertion of a needle to extract prostate tissue for analysis), particularly in the presence of symptoms.
- Men with a PSA level below 2.5 ng/mL may only require biennial retesting. Annual screening is recommended for individuals with PSA levels of 2.5 ng/mL or higher.
Useful Tips
Important Warnings
- Remember that cancer may still develop despite normal results from both the PSA test and a DRE.
- Discuss your family history, age, and any symptoms with your healthcare provider to ensure an informed diagnosis regarding your prostate health.
