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Do I Have to Get a Prostate Exam, Really?

The notorious test that elicits groans but effective preventive treatment

Photo credit: Trunk

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Q: A buddy of mine was recently diagnosed with prostate cancer, and it really freaked me out. We are both the same age (52), into healthy eating and fitness (we even play basketball together on weekends), so if this happened to him, I am worried that it can happen to me too. I’ve never had my prostate checked, and now I’m wondering if I should, just to be safe. But I’m really nervous because my friend told me about some of the less-than-pleasant parts of the process. Do you think I should get checked out? If so, is it as terrible as I’ve heard? 

Sincerely,

“On the Fence”

Dear On the Fence,

I’m sorry to hear about your friend. It’s great, though, that he has inspired you to take a proactive approach to your health. Many men share your concerns about getting their prostate checked, but it’s important because prostate cancer—the second most common cancer in American men—is extremely treatable when caught in its early stages.

And the process we use for early detection isn’t nearly as bad as you think. Seriously.

There’s been some debate recently throughout the medical community about who exactly should have their prostate checked and when. That’s because it’s unclear if the benefits (e.g., early detection) of testing all men outweigh the risks (e.g., finding and treating a large number of low-risk, slow-growing cancers that likely wouldn’t have caused any issues during the patient’s lifetime).

So the very first thing you should do is speak with your urologist and weigh the pros, cons and uncertainties of a prostate test in a process we like to call "shared decision making." Together, you and your doctor can make a choice that’s right for you. This will be based on several factors, including your age, race, family history and health priorities.

Next, you and your doctor will either decide to move ahead with a prostate check or to hold off. If you do go ahead with it, don’t worry—the process is very simple.

“Too many men go through the prostate screening process alone because they are embarrassed, uncomfortable or don’t want to appear afraid. Men who take advantage of their support network find the process far less stressful.”
Lee Richstone, MD

Your doctor will probably do a blood test. It’s called a prostate-specific antigen test, or PSA, and it’s used to screen for prostate cancer. This isn’t a definitive method for diagnosis, but in general, the higher the levels, the greater the chance of you having this cancer.

When you talk about being nervous about the screening process, I assume you’re referring to the dreaded digital rectal exam (DRE). I understand that having a lubricated, gloved finger inserted into your rectum may not be at the top of your bucket list, but it’s an important test that allows your doctor to feel for any abnormalities around the prostate. Try to keep in mind that this is a normal procedure that many men have to go through at some point, and it’s an essential step toward keeping you healthy and hopefully avoiding medical complications down the road.

If the PSA test or DRE turns up anything unusual or suspicious, your doctor may recommend a biopsy to make an official diagnosis.

My biggest piece of advice: Talk about your fears, concerns and experiences with someone you feel comfortable confiding in, whether it’s your doctor, a friend, partner or family member. Too many men go through the prostate screening process alone because they are embarrassed, uncomfortable or don’t want to appear afraid. I can tell you from my many years of experience that men who take advantage of their support network find the process far less stressful.

Dr. Lee Richstone, Urologist | Photo credit: The Well

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Published January 23rd, 2018

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