# Prostate exams: "Like he was going after the last pickle in the jar!" **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [September 24, 2006, 6:28pm UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965 "2006-09-24T18:28:34Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [September 24, 2006, 6:28pm UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/1 "2006-09-24T18:28:34Z")
In one of the early [Corner Gas](http://www.cornergas.com/episodes/?volume=1&issue=16) episodes, Brent’s parents pressure him to go to the doctor. He doesn’t wan’t to, because he knows he’s due for a prostate exam. Eventually he goes. That night, in the bar, he’s still grumbling about it, and Paul the barkeep says, “So did he…?” And Brent replies, “Yep, like he was going after the last pickle in the jar!” Then he looks over and sees another patron, about to crunch into a big dill pickle, who has obviously been put off by the image he got from the conversation, and mutters, “Sorry.”. All of which is a long intro to the fact that this is [Prostate Cancer Awareness Week](http://www.cancer.ca/ccs/internet/standard/0,3182,3172_15064_99055709_langId-en,00.html) (in Canada, at any rate). Prostate cancer is the third most common cause of cancer death for Canadian men, but like all cancers, the earlier it is detected, the better the survival rate. So guys, if you’re over 40, go get that pickle checked out! Brent Butt and [Red Green](http://urologyinstitute.ca/news.asp?ID=56) will both be rooting for you! (Sorry - another disturbing image. :eek: ) And yes, I’ve taken my own advice. I’m fine, thanks. 🆒 ---
**Author:** ![Astroboy14](https://avatars.discourse-cdn.com/v4/letter/a/df705f/32.png) [@Astroboy14](https://boards.straightdope.com/u/Astroboy14)\ **Post date:** [September 24, 2006, 6:45pm UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/2 "2006-09-24T18:45:46Z")
[QUOTE=Northern Piper] So guys, if you’re over 40, go get that pickle checked out! [/size] [/QUOTE] I’m 40. That means I can put it off another year, right? 😉 ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [September 24, 2006, 7:33pm UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/3 "2006-09-24T19:33:04Z")
Nope - you’re now over 40! (40 years + however many days since your last birthday). No shirking! Get going! 😛 ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 24, 2006, 7:33pm UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/4 "2006-09-24T19:33:47Z")
Just FYI: > [@](#): > > The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE). [http://www.ahrq.gov/clinic/uspstf/uspsprca.htm](http://www.ahrq.gov/clinic/uspstf/uspsprca.htm) Now, if you’ve got a significant family history of prostate cancer, or are a member of an ethnic group with a higher risk for prostate cancer, there is solid evidence that screening helps. But at this time, the evidence is not yet solid to recommend screening on low-risk asymptomatic men just because they turn a certain age. Perhaps soon we’ll see more data which will make for more firm recommendations one way or the other. ---
**Author:** ![KlondikeGeoff](https://avatars.discourse-cdn.com/v4/letter/k/3e96dc/32.png) [@KlondikeGeoff](https://boards.straightdope.com/u/KlondikeGeoff)\ **Post date:** [September 24, 2006, 11:23pm UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/5 "2006-09-24T23:23:06Z")
[QUOTE=\*\*Qadgop \*\*the Mercotan] But at this time, the evidence is not yet solid to recommend screening on low-risk asymptomatic men just because they turn a certain age. [/QUOTE] I keep hearing and reading about this, Dr. \*\*Qadgop \*\*, but my question is, “What’s the harm?” To me, regardless of the risk factor, if anybody feels it would be wise to check it out, they should. [From a 5.5-year prostate cancer survivor who is glad he went. who does, however, admit he is well over 40!.] ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [September 25, 2006, 12:37am UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/6 "2006-09-25T00:37:25Z")
A lot of people take the view that you are better off getting whatever test at a younger age, since if you detect whatever sooner, you can treat it and you’re better off. But it’s more complicated than that – even if talking about mammograms in 39 year old women, business executives paying for full body CT scans in case there is a cancer somewhere, or getting a prostate exam or PSA test, or doing a self breast exam. There a several reasons why. The intervention may not be good enough to reliably detect disease; there may not be proof early intervention is helpful; the test may detect benign things, lead to unneeded treatment and then added stress and complications; the test may give false reassurance if negative; the tests and extra visits may be expensive. Early mammograms are good at detecting DCIS (ductal carcinoma in situ). These are often treated aggressively as “precancer”, but the jury is still out on whether this is warranted – surgeons often think it is, epidemiologists are less sure. Digital rectal exams and PSAs both miss cancers. Women may “get in touch with their body” by doing self breast exam, but does it reduce mortality? More tests mean more false positives – you may not have a significant lesion, but if you are told you do, you’re going to worry about it. Tests have their place, of course. But there’s more to it than most people think about. Examination of prostates from cadavers show pre-cancerous lesions in the vast majority. And prostate cancer didn’t kill most of them. But prostate cancer kills some, and many people have bad complications from treatment – pain, impotence, infection, etc. Weighing the risks and benefits can be tricky. ---
**Author:** ![C\_K\_Dexter\_Haven](https://avatars.discourse-cdn.com/v4/letter/c/b2d939/32.png) [@C\_K\_Dexter\_Haven](https://boards.straightdope.com/u/C_K_Dexter_Haven)\ **Post date:** [September 25, 2006, 12:47am UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/7 "2006-09-25T00:47:42Z")
Well, in the case of PSA exams, weighing risks and benefits doesn’t seem to me to be tricky at all. I have a cousin who died of prostate cancer. He didn’t believe in annual check-ups, so by the time they found the cancer, there was nothing that could be done. His death was long and painful, both for him and for his family, with him bed-ridden for almost a year. And the consensus of every doctor was that if had had annual medical exams, this would probably have been found early and almost certainly been curable. Sure, there’s a “probably” and a “almost certainly” – but there’s no downside to the test. My doctor looked at my PSA scores last April and was suspicious, so sent me for a biopsy (not pleasant) which detected slight cancer. I had a labroscopic prostatectomy in June; the cancers were entirely contained in the prostate, so presumably I am now cancer-free. I am very grateful to my doctors for catching this early. Yes, prostate cancers can be very slow-growing. “Wait and watch” is a legitimate approach. That didn’t seem reasonable for me, based on my age and the early detection: I didn’t see any advantage in waiting to see whether the cancer spread. So my very strong message to every male after age 40: get a check-up. There are a number of diseases that are fatal, but can be treatable if caught early, such as skin cancer, prostate cancer, some types of heart problems, etc. The cost/inconvenience of an annual medical check-up seems a small price to pay compared to, say, death. ---
**Author:** ![Cartooniverse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cartooniverse/32/3084_2.png) [@Cartooniverse](https://boards.straightdope.com/u/Cartooniverse)\ **Post date:** [September 25, 2006, 12:54am UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/8 "2006-09-25T00:54:56Z")
I think this makes **QtM** [the Pickle Man](http://www.melbourneloft.com/images/2005NewYork/IMGP0469.JPG). This would be **QtM** on the left, packing a gallon of his Kosher Extra Sour finest whilst explaining patiently to the ravenous tourist that no, he isn’t interested in opening a branch on Fisherman’s Wharf and yes, these are those real " Jewish Pickle Things " that she heard about back in Oregon. 😃 I had the PSA this year and at 44 is two years overdue since last Pickle Check. :eek: " How can you check my pickle when I’m hung like a gherkin? " 😛 Cartooniverse ---
**Author:** ![pullin](https://avatars.discourse-cdn.com/v4/letter/p/c57346/32.png) [@pullin](https://boards.straightdope.com/u/pullin)\ **Post date:** [September 25, 2006, 1:53am UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/9 "2006-09-25T01:53:14Z")
I am known for trying to scramble away when the doc conducts this exam. Therefore, he grabs hold of my shoulder with his free hand (to restrain me). Once I commented that it always makes me nervous when I feel his hand on my shoulder. His comment: “You don’t need to worry unless you feel _both_ my hands on your shoulders.” :eek: To which I laughed: “Haaa haahhahaaa… AAAAUGH ha ha…” ---
**Author:** ![Cat\_Whisperer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cat_whisperer/32/4839_2.png) [@Cat\_Whisperer](https://boards.straightdope.com/u/Cat_Whisperer)\ **Post date:** [September 25, 2006, 2:13am UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/10 "2006-09-25T02:13:29Z")
For a little light entertainment on the subject: [The Family Guy.](http://www.nearlygood.com/video/familyguyprostateexam.html) Sphincter. ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [September 25, 2006, 3:38am UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/11 "2006-09-25T03:38:34Z")
Weighing risks and benefits for PSA may not be tricky for you. I do PSAs on my patients too. But with some reservations. According to [http://www.medscape.com/viewarticle/512482](http://www.medscape.com/viewarticle/512482) > [@](#): > > Summary > Many men with prostate-specific antigen (PSA) levels lower than the traditional cutoff (4 ng/mL) for biopsy have occult prostate cancer (Journal Watch Jun 8 2004), leading some authorities to argue that the threshold should be lowered. Dartmouth researchers used PSA data from the National Health and Nutrition Examination Survey (2001-2002), and other data on prostate cancer treatment and mortality rates, to estimate the effects of lowering the PSA cutoff to 2.5 ng/mL. > > At the 4 ng/mL cutoff, about 1.5 million American men (age range, 40-69) would be labeled as having abnormal PSA levels. If the cutoff were lowered to 2.5 ng/mL, an additional 1.8 million men would be labeled as having abnormal levels. If those 1.8 million men underwent biopsies, 450,000 would be diagnosed with prostate cancer. If all 450,000 underwent radical prostatectomy, 180,000 would become impotent, 40,000 would have at least moderate incontinence, and 1000 would die from the surgery. > > Among men aged 50 to 59, 11% have PSA levels higher than 2.5 ng/mL, but only 0.3% are likely to die from prostate cancer in the next 10 years (according to statistics from the pre-PSA era). Among men aged 60 to 69, these figures are 17% and 0.9%, respectively. > > Comment > These researchers note that only a tiny fraction of men with PSA levels higher than 2.5 ng/mL will die from prostate cancer during the next 10 years, but large numbers of these men would be subjected to morbidity associated with surgery. The authors, who clearly are skeptical about PSA screening, conclude that lowering the PSA threshold “would be a mistake.” > > — Allan S. Brett, MD ---
**Author:** ![kezami](https://avatars.discourse-cdn.com/v4/letter/k/eb8c5e/32.png) [@kezami](https://boards.straightdope.com/u/kezami)\ **Post date:** [September 25, 2006, 4:29am UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/12 "2006-09-25T04:29:16Z")
I don’t feel that I’m at any great risk since I exercise my prostate religiously; out with the bad in the the good, you know. ---
**Author:** ![jayjay](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jayjay/32/6765_2.png) [@jayjay](https://boards.straightdope.com/u/jayjay)\ **Post date:** [September 25, 2006, 4:34am UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/13 "2006-09-25T04:34:58Z")
[QUOTE=kezami] I don’t feel that I’m at any great risk since I exercise my prostate religiously [/QUOTE] _snerk_ “Oh, god! Oh, god! Oh, god! Jesus! Oh, god! Oh, god!..” ---
**Author:** ![Cat\_Whisperer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cat_whisperer/32/4839_2.png) [@Cat\_Whisperer](https://boards.straightdope.com/u/Cat_Whisperer)\ **Post date:** [September 25, 2006, 4:39am UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/14 "2006-09-25T04:39:30Z")
Worshipping at the altar…? ---
**Author:** ![Cartooniverse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cartooniverse/32/3084_2.png) [@Cartooniverse](https://boards.straightdope.com/u/Cartooniverse)\ **Post date:** [September 25, 2006, 11:31am UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/15 "2006-09-25T11:31:31Z")
That’s " alter" 😛 ---
**Author:** ![Tomcat](https://avatars.discourse-cdn.com/v4/letter/t/8e8cbc/32.png) [@Tomcat](https://boards.straightdope.com/u/Tomcat)\ **Post date:** [September 25, 2006, 11:52am UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/16 "2006-09-25T11:52:45Z")
I’ve had one of these tests once for a 1st class flight physical. He was in, he was out. What exactly are they looking for? (and, if I so chose, can I do it on myself?)(I mean, not that I want to, but if I did)(or maybe had the dominatrix I visit do it, y’know “Oh please mistress, don’t do that! But if you do, could you check for any irregular bumps while you’re at it?”) 😛 -Tcat ---
**Author:** ![C\_K\_Dexter\_Haven](https://avatars.discourse-cdn.com/v4/letter/c/b2d939/32.png) [@C\_K\_Dexter\_Haven](https://boards.straightdope.com/u/C_K_Dexter_Haven)\ **Post date:** [September 25, 2006, 12:59pm UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/17 "2006-09-25T12:59:11Z")
I am not a doctor, but I have had plenty of education on the prostate in the last six months. The prostate gland is located way in the back, near the rectum, so it’s easiest to get at from that direction. They do a biopsy that way, too. With the digital exam, the doctor is feeling for any irregularities in shape, hardness, etc that might imply a tumor or other abnormalty. Amount of activity has no relationship to whether you get cancer there, **kezami** , just like people who breathe regularly still get lung cancer. And, for my personal experience, my PSA score was low – 3.5 – which is below the standard for further checking. But my doctor (bless him!) had noticed an increase from year to year over the last five years – an advantage to annual physicals with the same doctor – and we discussed whether to do a biopsy. I thought it made sense. When they found a cancer, the urologist said very honestly that if I had been his patient, he would not have done a biopsy based on PSA score and digital exam. ---
**Author:** ![kezami](https://avatars.discourse-cdn.com/v4/letter/k/eb8c5e/32.png) [@kezami](https://boards.straightdope.com/u/kezami)\ **Post date:** [September 25, 2006, 1:30pm UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/18 "2006-09-25T13:30:43Z")
[QUOTE=C K Dexter Haven] Amount of activity has no relationship to whether you get cancer there, **kezami** , just like people who breathe regularly still get lung cancer. [/QUOTE] And I thought I was doing it for peace of mind. Oh well, pure hedonistic pleasure will have to be my motivation now. ---
**Author:** ![BarnOwl](https://avatars.discourse-cdn.com/v4/letter/b/e95f7d/32.png) [@BarnOwl](https://boards.straightdope.com/u/BarnOwl)\ **Post date:** [September 25, 2006, 1:53pm UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/19 "2006-09-25T13:53:03Z")
The prostate check will be much less uncomfortable if you lie on your side and assume the fetal position. Some doctors won’t tell you that, and I wonder why. ---
**Author:** ![Inigo\_Montoya](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/inigo_montoya/32/124_2.png) [@Inigo\_Montoya](https://boards.straightdope.com/u/Inigo_Montoya)\ **Post date:** [September 25, 2006, 2:27pm UTC](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965/20 "2006-09-25T14:27:53Z")
[QUOTE=BarnOwl] The prostate check will be much less uncomfortable if you lie on your side and assume the fetal position. Some doctors won’t tell you that, and I wonder why. [/QUOTE] I can’t see me getting one any other way… [Next page](https://boards.straightdope.com/t/prostate-exams-like-he-was-going-after-the-last-pickle-in-the-jar/373965.md?page=2)