Digital Rectal Examination (DRE)

[Michael Scally MD]

Koulikov D, Mamber A, Fridmans A, Abu Arafeh W, Shenfeld OZ. Why I cannot find the prostate? Behind the subjectivity of rectal exam. ISRN Urol. 2012:456821. http://www.hindawi.com/journals/isrn/2012/456821/

Background. Most physicians use Digital Rectal Examination (DRE) to help detect prostate cancer and to estimate the prostates' size. The accuracy of DRE is known to be limited. We evaluate the ability of doctors to palpate the whole prostate with DRE.

Methods. At time of transrectal ultrasound (TRUS) the distances from the anus to the apex and base of prostates were measured. The TRUS's distances were compared to the mean index finger length of our clinic doctors.

Results. The ability of the urologist to reach and examine the apex, half, three quarters and the whole prostate was in 93.7%, 66.3%, 23.2% and 3.2% of cases respectively.

Conclusions. In most cases it was impossible to palpate the whole prostate. Anatomical location and volume of the examined prostate, as well as the length of his own index finger limit DRE and allow the examination of only a small portion of the prostate.

 

[Kinikuman]

No, no, noooooo!!! You mean I lost my virginity to that fat fingered bastard for nothing? And then all those other guys I let do me?! I feel so dirty and used...

 

[Dr JIM]

Hey good luck if you can locate a contemporary non-urological graduate that even knows how to differentiate an abnormal from a normal prostate.

Many physicians (esp techno docs) wrongly rely on the PSA to determine whether "you got a prostate problem". .

 

[Michael Scally MD]

Hey good luck if you can locate a contemporary non-urological graduate that even knows how to differentiate an abnormal from a normal prostate.

Many physicians (esp techno docs) wrongly rely on the PSA to determine whether "you got a prostate problem". .

WRONGLY - Can NOT be stressed enough.

 

[MR10X]

The size of your prostrate doesnt necessarily mean you have cancer. Mine has never been enlarged and i never had urination problems,after a DRE by primary he said it was normal and didnt feel any lumps. But a PSA score came back 5.5 so he sent me to a eurologist.I went to a euro about 5 months later and he did a DRE and said it was normal but a PSA came back 11.2. He then did a biopsy and sonogram of 12 locations and it came back high grade cancer......

 

[Michael Scally MD]

The size of your prostrate doesnt necessarily mean you have cancer. Mine has never been enlarged and i never had urination problems,after a DRE by primary he said it was normal and didnt feel any lumps. But a PSA score came back 5.5 so he sent me to a eurologist.I went to a euro about 5 months later and he did a DRE and said it was normal but a PSA came back 11.2. He then did a biopsy and sonogram of 12 locations and it came back high grade cancer......

Very informative and supportive of the literature.

 

[Oregongearhead]

I have enlarged prostate and ALL the symptoms that go with it but low PSA (0.66)
Im still weighing the pro's & con's of greenlight surgery....~Ogh

 

[Dr JIM]

I have enlarged prostate and ALL the symptoms that go with it but low PSA (0.66)
Im still weighing the pro's & con's of greenlight surgery....~Ogh

Has medical therapy been attempted?

 

[Oregongearhead]

Has medical therapy been attempted?

Ive done nothing about it , from all the propaganda I have not tryed Finasteride although Ive tryed alpha-blockers and Cialis . Ive been putting it off Doc .

 

[Burrr]

As AAS users, is there anything we should be doing/ not doing to prevent prostate problems? I assume keeping estro in check is important, and routine checks for us older dudes.

 

[Dr JIM]

Ive done nothing about it , from all the propaganda I have not tryed Finasteride although Ive tryed alpha-blockers and Cialis . Ive been putting it off Doc .

Many patients respond to Alpha blocker therapy alone for BPH.

I've had very good success with Uroxatral mono-therapy for BPH.

Alpha blockers work by relaxing the "spincter" which encircles the prostate glad and do NOT effect DHE or TT levels.

More importantly their onset of action is rapid (as little as a single dose may improve symptoms) unlike "DHT Blockers"

Ask your DOC for some samples to try mate

 

[Dr JIM]

Ive done nothing about it , from all the propaganda I have not tryed Finasteride although Ive tryed alpha-blockers and Cialis . Ive been putting it off Doc .

Just bc one particular AB was ineffective does not mean
all will be.

The point, patients are best advised to try several ABs before committing to surgical intervention, IMO.

 

[Oregongearhead]

Just bc one particular AB was ineffective does not mean
all will be.

The point, patients are best advised to try several ABs before committing to surgical intervention, IMO.

Thanks Dr.Jim - Im gonna ask about Uroaxtral and try AB"s again . Something about a laser being shot up my butt doesnt sit right with me ......

 

[Burrr]

As a guy that has reached the age of routine prostate exams I'd be lying if I said I didn't look at the size of a doctors hands when picking a family physician. A young lady doctor just opened up a practice across the street from me, and I was already thinking about her tiny little fingers, lol.
Looks like I should stick with my original doc, with his man hands and 30+ years of doing DRE's. That guy left my insides sore for a couple days, it felt like he was trying to push my bellybutton back out.

 

[MR10X]

If you think a finger is bad,wait till they jam a scope and then use a 12 inch long needle to take samples of your prostrate up your butt.........

 

[Burrr]

Yes, that does put things into perspective.

 

[MR10X]

I don't want scare anyone about the biopsy,it was not that bad.I was nervous about it,but it wasnt that bad.No real pain but the hard scope was a little uncomforable but its not as bad as it is made out to be.....its pretty much the only way they will know for sure if you have cancer,and the sooner you treat it the better off you are,You dont want it spreading outside the prostrate.......Its been 2 years since my radiation and seed implants and my last PSA came back 0.40,a lot better than the 11.2........

 

[Dr JIM]

Thanks Dr.Jim - Im gonna ask about Uroaxtral and try AB"s again . Something about a laser being shot up my butt doesnt sit right with me ......

No no no mate, if they are going to trim off that obstruction to improve urine flow it's done from INSIDE the prostate which is why the abbreviation is a TURP (Trans Urethral Resection of the Prostate).

The procedure has been performed for decades and the only difference is the "Resection" component is performed by a laser rather than a rotary scalpel.

But the effort to shave off that obstruction to urine flow is actually done by accessing the prostate from INSIDE the penis.

The procedure is VERY SAFE with about the only common, yet expected, complication being bloody piss for 2-4 days and the occasional "bladder infection". The latter being much less common.

Seriously I've never had a patient with a "serious or life threatening" complication from a TURP, and many patients go home the same day as the procedure itself.

So if you find the thought of using a DHT blocker problematic have the TURP done.

That being said some 98% of patients "respond" to dual AB and "DHT blocker"
therapy.

One HUGE advantage to the TURP is the pathologist can and does look for cancer within many of the shaved pieces of prostate.

 

[Oregongearhead]

Thanks Dr.Jim , making an appointment next week . Its not so bad off cycle, getting up 2-3 times a night for a leak ; but when Im ON it can be up to 8-10 times a night . A man cant sleep like that ....

 

[Dr JIM]

The frequency issue is invariably a sphincter problem and almost always responds well to ABs, IME.