Doctor’s Advice: Yes to Rectal Exams

The rectal exam….yes, you need to have it done.

I can predict the moment in my conversations with patients when I’m gonna see “the grimace.”  It’s right at that moment when I go over what is involved in the urologic exam, “first we examine the penis and testicles and then sir you just turn around, place your elbows on the table, and we check your prostate”…then I hear the scoff and see the bitter beer face of the medical world. “Doc do we really need to do that?” I always let patients know that I won’t do anything they are uncomfortable with, but for most men, this is a necessary and integral part to diagnosing their medical condition.

Let’s sort out why a rectal exam is necessary and something you should feel comfortable with in your doctor’s office.

Prostate cancer and other benign diseases of the prostate are common; especially in men over 50. There has been a lot of controversial news regarding prostate cancer screening and many men saw this news as their “way out” of rectal exams. Unfortunately, this approach is somewhat irresponsible in trying to make a gray issue fit into black and white parameters.  Does every man over 50 need a prostate exam and PSA every year? Probably not. People who have a family history of prostate cancer or with other risk factors probably do. This decision is best made in conjunction with your Family Physician or Urologist. Men with a first degree relative (brother, dad) with prostate cancer would benefit from being screening in their 40s in most cases. Most men with low risk should have baseline testing and then a plan for screening can be developed with their physician (low risk patients may only need testing every 2-5 years).

What exactly is screening for prostate cancer? It’s quite simple, a blood test called PSA (prostate screening antigen) and the digital rectal exam. These tests don’t do the job unless used together to give the physician an accurate summation of your risk. The digital rectal exam is often dreaded not only because it can be uncomfortable but also because many men feel this is a vulnerable position to be in with a relative stranger, their doctor.

I want to encourage you to be brave! I find that most patients find the exam much less of a “big deal” then it was built up to be prior to their visit. The exam last less than 5-10 seconds in most instances. The doctor can easily feel the outside of the prostate in that time; looking for hard nodules or asymmetry that may be suspicious for prostate cancer. Ten seconds of discomfort in the privacy of the doctor’s office, c’mon that’s a very small commitment to make to your health.

The PSA is the other part screening. PSA is a protein normally produced in the prostate and is important for liquefying semen.  When cancerous cells are present in the prostate this protein gets over produced, which elevates the levels in your bloodstream. When the PSA is checked and the value is found to be elevated, there is a risk that this elevation may be due to prostate cancer. There are benign reasons to have an elevated PSA. Such as an enlarged prostate or a urinary tract infection which again makes the rectal exam an important key to this puzzle. If the doctor determines your risk is significant for cancer, then a prostate biopsy will be considered.

What other circumstances will you be asked to drop trow? Typically most urinary conditions in men are diagnosed with the aid of a rectal exam. Whether its because you are getting up at night, notice that you have a weak stream or that you have pelvic pain, the prostate is likely to have a hand in these problems.

Patients frequently ask me, “what is the prostate?” and “do we need it?” The prostate is a walnut sized organ sitting up against the bladder and surrounding the proximal portion of the urethra and its job is to produce a portion of the fluid that makes up semen. You can live without it  (women don’t have prostates) and many men have their prostate removed in order to cure them of prostate cancer.

So, next time you’re in the doctor’s office for an annual physical, know that cooperating with the full exam, including the digital rectal exam (DRE) is just as helpful as letting them listen to your heart and lungs or checking your cholesterol.  Keeping your genitals healthy and in top condition is important to maintaining a healthy sex life… now who wouldn’t support that?

– Dr. Amy

Dr. Amy Schlaifer is a urologic surgeon practicing in Phoenix, AZ.

Thumbnail image via Family Guy