At some point, most men have to go through a prostate examination as a part of general health screening, or they are advised to get this test done due to their age or other medical factors.
The prostate gland produces most of the fluid part of the semen. The presence of this gland is barely noticed by those who are healthy. Most men only take notice of it when some troubling symptoms start to appear, like frequent and painful urination, lower back pain, interruption in the flow of urine and retention of urine in the urethra (signaled by dribbling urine in underclothes). While most people suspect cancer when the prostate gland is mentioned, other less serious conditions also afflict the prostate like inflammation (prostatitis) and increase in size (hypertrophy).
The prostate is a small gland located below the bladder and in front of the rectum. It weighs about 20 to 25g in a healthy adult male. The urethra passes from the bladder, through the prostate and then through the shaft of the penis. The chief function of the prostate is to secrete a fluid that provides nourishment for sperms.
Examination of the Prostate Gland
There are various ways of checking for abnormalities of the prostate. Presence of hard lump-like areas, nodules, or sunk-in regions are considered abnormal. Apart from the methods for direct examination of the prostate, a blood test for higher-than-normal amount of a particular protein produced by the gland is done to detect cancer or other conditions. Because the prostate is surrounded by organs, it is not directly accessible. It can be palpated through the wall of the rectum.
Digital Rectal Examination (DRE)
This is the most widely used procedure used for assessing the size and texture of the prostate. A doctor inserts a gloved finger (usually index finger) into the rectum to feel the prostate. The finger is lubricated to avoid pain and discomfort to the patient.
The patient is asked to remove his trousers and underclothes. To facilitate the DRE, he is then asked to orient himself in a certain position. The positions usually used for a DRE are:
Left Lateral Position: The patient lies down on his left side with the knees drawn close to the chest.
Lithotomy Position: The patient lies on his back, with knees raised up and drawn close to the chest.
Knee-chest Position: The patient kneels with elbows resting on the examination table or bed.
Many times, the patient is simply asked to stand with feet apart, toes bent inwards and knees flexed slightly. Then, he is asked to bend over and rest his hands on the examination table.
When the patient is in the appropriate position, the buttocks are drawn apart to expose the anal region. The perineum (region between anus and scrotum) is examined for signs of injury or disease. The finger is inserted into the rectum. It is slowly moved over the rectal wall to feel the two lobes of the prostate, and the groove (depression) between them. Irregular lumpy areas or nodules, tenderness, uneven or sunk-in areas, hard and firm areas, inability to feel the groove between the two lobes of the prostate; all these are what doctors particularly look for in a DRE.
The posterior and lateral part of the prostate can be palpated (felt) in the examination; however, some part obviously remains out of reach. When the examination is over, the finger is removed, the patient is given some tissues to wipe off the lubricant, and asked to put on his clothes.
Is Prostate Examination Necessary?
Some people feel that a prostate exam should not be a part of the regular health checkup. This might be because they find the procedure embarrassing, painful or simply unnecessary. However, in case of prostatic cancer, early screening is vital. Men of African-American ancestry are at a higher risk of being afflicted by prostate cancer. As a man ages, the risk of cancer increases too, and it is generally recommended that men above 50 years of age should have a prostate exam as a part of the regular health checkup. DRE should be avoided if the patient is suffering from neutropenia.
There are other types of examinations and tests that are used along with DRE to confirm a suspected diagnosis or to distinguish between closely related signs of two different diseases. These tests are:
Prostate-specific Antigen (PSA) Test: Protein-specific antigen (PSA) is a protein produced by the prostate gland. The PSA level is usually elevated in conditions like prostate cancer and prostatitis. It is, therefore, an important parameter for knowing about pathological conditions of the prostate. However, it is not a very reliable parameter on its own, and its significance depends upon the results you get from other tests.
Transrectal Ultrasound (TRUS): In this procedure, a sound wave emitting device, known as a TRUS probe, is inserted into the rectum. For this, an ultrasound gel is applied to the probe which is covered in a sheath. It emits sound waves that bounce off various organs including the prostate. From the reflected sound waves, an image of the prostate is created. This procedure can detect irregularities that a DRE has missed. It also reveals the size of the prostate.
Prostate Biopsy: If a patient’s DRE reveals abnormalities, and if his PSA is elevated, then a biopsy (removal of tissues for further tests), is done to confirm a suspected diagnosis. The biopsy sample is taken with the assistance of transrectal ultrasound (TRUS). A needle attached to the TRUS probe is guided to various points, from where samples of prostate tissues are taken.
A prostate exam should not be shied away from, as it reveals the very early signs of prostate gland problems. It becomes especially relevant, given the high mortality rate of people with prostate cancer.
Disclaimer: This article is for informative purposes only, and should not be used as a replacement for expert medical advice.