At what age is a prostate exam something you should put on the calendar (and then put calendar in kitchen drawer to ignore)? And how often after that?
I had my first at 40 and then a couple more in the past 8 years. That doesn’t count the time I had an anal fissure fixed and the doc noted my prostate looked fine.
I’m sure I’ve read the age of fifty, unless there is a history of problems in your family.
Are you referring to a prostate ‘finger wave’, in which the Doc feels the size of the organ, or, are we talking a colonoscopy?
I’ve had both a finger wave and and an a colonospocy because my numbers were high according to my blood check.
After further examination (And I mean very thorgh) I was deemed OK!
Just my thoughts.
BTW Im Im’a patient of the VA.
I wish I had a good answer for when and how to best screen healthy, asymptomatic low-risk for prostate cancer. It’s a muddled issue.
What I do: Recommend digital rectal exams annually on all african-american men, as they have the highest rate of prostate cancer in the world. Serum PSA testing may play a role in screening them too, but maybe not.
I also recommend the digital rectal exams on all men over 50 annually. The role of the PSA test is even murkier for non-black men. I usually don’t order it.
Of course, if you’re a member of an even higher risk group, like men whose fathers have had prostate cancer at an early age, then earlier screening may be desirable. And if you’re black, and dad had prostate cancer at age 38, and so did uncle, and older brother, go get checked now!
And guys, know the warning signs for prostate disease:
• Frequent urination, especially at night
• Difficulty initiating urination
• Inability to urinate
• Weak or interrupted flow of urine
• Painful, burning urination
• Painful ejaculation
• Blood in urine or semen
• Frequent pain or stiffness in the back, hips or upper thighs
OOPS! I mean I recommend digital rectal exams annually on all african-american men over the age of 40!
mass postate screening is still controversial. Around 80% of 80 year olds and 90% of 90 year olds will have some form of postate cancer. There is no evidence that aggresive surgery helps life spans (a swedish study showed that while surgery and drugs reduced the death rate from postate cancer itself, overall death rates did not alter). Indeed any screening that tells large numbers of people they have cancer but cannot do anything about it must be wrong (apart from any research benefits of course)
At a dinner of doctors I attended (my wife is a GP) all the male doctors stated that if diagnosed with PC they would rather “wait and see” than have surgery which has known possible complications of incontinence and impotence to name a few.
Lots of links out there e.g http://nydailynews.healthology.com/query.asp?f=men&c=prostate_screen&pro=0
Thanks to all for the reply.
So when do the colonoscopy and for what reasons? I assume it checks for other cancers and/or/nor prostate?
As to the sentence quoted above, what did you mean? Did you mean that telling people they have a cancer that can not be cured is not helpful or ethical, etc? Seems like there is still good reason to know.
Why spend billions of dollars screening millions of people who don’t have symptoms to uncover a disease where it makes no difference if we find it early??
Any screening test to be used on people in general must be shown to make a positive difference in outcomes as a result of the test. Or why bother?
Oh, and as for screening for colon cancer, there is still no unanimity of opinion as to which is really the best screening method. Serial stool testing for blood, sigmoidoscopy, sigmoidoscopy with follow-up barium enema, and full colonoscopy have all been studied as screening tools for an otherwise low-risk asymptomatic patient. And thus far, checking 3 to 6 samples of stool from different days for blood content appears just as effective in reducing mortality from colorectal cancer as other modalites. It’s a lot cheaper and less invasive too.
But some sort of screening for colorectal cancer should be done starting at age 50.
Here’s the link describing the evidence: http://www.ahrq.gov/clinic/uspstf/uspscolo.htm
Note that the above recommendations are for asymptomatic people without special risk factors for colorectal cancer. Not for people with a strong family history of the disease, or those with symptoms.
Regarding Prostate screening, the US preventive task force doesn’t have a recommendation about screening asymptomatic people at low risk. As their site notes, the data is too contradictory to draw a firm conclusion as of yet. And with recent evidence showing PSA testing is pretty useless as a screening tool, don’t expect that to change soon.
And scm1001 cites good info regarding prostate cancer. One trouble with the wait and watch approach for everyone though is the fact that some prostate cancer is extremely aggressive, rapidly spreads, causes debility and death within a few years, and may be quite treatable and even curable if found early. Sadly it’s hard to know on tissue sample alone whether any one individual’s prostate cancer will be a slow-growing “leave it alone, you’ll be dead of other things before it’s a problem” type, or the “nuke it now before it’s too late” type.
Fortunately, the slower types predominate.
I just had a tumor and kidney removed and at the ward, there were lots of guys who’d had surgery of the prostrate in one form or another. Statistics is slippery and I’m neither a doc, nor privy to references and cannot provide cites, so you guys have to trust me on retelling what my doc told me.
About half of all men over 65 have some form of tumor desease of the prostrate. Many will never ever get any symptoms or suffer from this. Problem is how to treat the different form of cancer deseases. With testicular cancer, chemo therapy seems to be the way to go, fully curing about 97 % of the cases. With kidneys, as in my own case, it’s surgery (and a friggin big scar it made, about 10"),whereas chemo and radiation will not help a lot. Breast cancer is normaly treated by removing the tissue, get it under a microscope and then deciding if there is need to follow up with another type of therapy.
My doc, who removes prostates for a living, said (as QtM noted above), that it’s still a murky thing. Whereas removing part of a breast for a woman is a big step, there’s no finality to it. Ripping out the prostrate and sending it to a lab only to discover that it wasn’t very aggressive and that the patient could’ve lived a long happy, fully functional life, but is now, in effect, castrated, is not a good option.
My doc said that ultimately, the decision lies with the patient, but that it is a gamble and that he wishes it were as clear cut as it is with kidneys and testicular cancer.
You could ask yourself - would you want to make that decision? If you don’t have any symptoms, your prostrate isn’t giving you any problems, would you want a blood sample to tell you that you have a microscopic tumor that might, or might not, kill you in 30 years, if you aren’t dead from something else before? And would you then decide to spent the rest of your life castrated?
For me - it was much easier. Get in, get surgery, get out. Declared fully recovered, all in six weeks.
I guess I assumed that there could be complications and that there could be some quality of life issues improved or at least symptoms explained or later avoided. Isn’t it easier to treat if it is caught early regarding quality of life if not saving life? Just seems odd to let cancer go…can’t it spread, cause other complications or interactions that might be important, etc?
Castrated? Is that even loosely correct? I don’t know, just asking?
I guess if you have it “ripped out” they could start a new line of business in replacing them, perhaps with pig or baboon prostates.
One must do more good than harm with screening tests.
Take ovarian cancer for example. Virtually without symptoms until it’s too late to cure. Then you die.
One can find it with a pelvic ultrasound, before it is so far advanced. Early enough to cure it. So do we ultrasound every woman over 25 every year for the rest of her life? It’ll cost billions, and we’ll have to train thousands of more ultrasound techs, and radiologists to read the ultrasounds.
Oh, by the way, ovarian cancer is rare enough that for every case you find, you’ll have about 15,000 false positives for it on the ultrasound. (I’m approximating these numbers, as I don’t have them at my fingertips). So for those 15,000 they’ll have to have laparoscopy, an invasive surgical procedure. About 150-300 of those will have significant complications from the procedure (1-2% complication rate) and 1-3 will die from the complications.
So to pick up one cancer early enough to save a life, Billions have been spent and 1 to 3 people have died, and 150-300 have been sickened.
It’s the law of unintended consequences.
Thanks as usual for all the good ifo, QtM.
I have a friend who was diagnosed with thyroid cancer at 30. Very scary- if his wife wasn’t an RN he might have ignored the small lump and we would have lost him.
As part of his follow up, he must have colonoscopies every year (or every other year, I can’t remember which). The first one was when he was about 31 or 32, and they said he had more polyps than his dad! So he is at risk for any number of bad things down the road.
But I don’t know anyone in a non-high-risk group who gets any tests in their 30’s. My husband hasn’t been in for a physical in years (not a good thing, just a fact). My only doctor visits are to my OB/GYN! Except that she couldn’t give me a Hep A shot so I did have to find a GP last year…
Actually, we call it cost-benefit analysis public policy. What I was trying to get at, on prostrate cancer, is that it seems a cheap exam (finger) might help in several ways, even if it wasn’t cureable.
It might. But so many borderline irregularities can be found on digital rectal exam that there can be more complications of biopsying every prostate that feels abnormal than benefits of discovering whether it’s cancer or not.
I’m 50 and exhibit most of the symptoms of BHP. I know that I need a DRE, but frankly have been too scared to have it done. I have no fear of what the doctor might find, but I’m really a coward when it comes to pain. Can some of you “veterans” of the procedure please fill me in on what to expect?
Thanks!