Do You Really Need a Prostate Exam?

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Thanks to the proliferation of awareness campaigns imploring men to take charge of their health, “men’s health” has become an important buzzword inspiring action while at the same time raising a lot of questions—especially regarding prostate cancer. Perhaps that is because prostate cancer is the second-leading cause of cancer death in American men, behind only lung cancer. Joseph Brito, MD, a urologist at Lawrence + Memorial Hospital and an associate professor of Urology at Yale School of Medicine, sees patients with urologic cancers in collaboration with the Smilow Cancer Hospital Care Center in Waterford and the Prostate and Urologic Cancers Program at Smilow Cancer Hospital. Here he offers advice about the importance of rectal exams, PSA (prostate-specific antigen) blood tests, and screenings for prostate cancer.

Who is most at risk for prostate cancer?

Prostate cancer is incredibly common. The biggest risk is age, as older men are more likely to be diagnosed with the disease. However, many of these patients may have low-grade prostate cancer, which means it’s very slow growing, unlikely to spread and doesn’t require treatment.

Patients at risk of more aggressive disease include those with a strong family history and those who are African American. There is also an association with the BRCA gene, so patients with a strong family history of breast cancer should also be monitored closely.

At what age should men consider getting a prostate check?

The American Urologic Association recommends prostate cancer screening starting at age 55 for men who are at average risk. Screening is generally not recommended in men over age 75 as the potential benefits are outweighed by the risks in this population. Men who are at high risk should begin screenings at age 45.

What does a prostate screening or test involve?

Prostate cancer screening includes a digital rectal exam (DRE) and PSA blood test. Depending on the results, your physician may recommend additional blood and urine tests or a prostate MRI.

Where should men go for a prostate check?

Your primary care provider should initiate most prostate cancer screenings. They will refer you to a urologist if the initial screening detects any abnormalities. Certain high-risk individuals may benefit from establishing care with a urologist early on.

What would you say to men who are hesitant about a prostate exam?

Many men are reluctant to be screened for prostate cancer, specifically when it comes to a rectal exam. It’s true that this exam is somewhat invasive; however, it is quick and usually fairly painless. And while many prostate cancers can be detected by the PSA blood test, there are those that are sometimes only detected by rectal exam. Screening allows for earlier detection of the disease, making treatment much more straightforward. Once prostate cancer metastasizes and spreads to other areas of the body, it generally cannot be cured.

What are the signs and symptoms of prostate cancer?

One challenge with prostate cancer is that the early stages often present without any symptoms—which is why regular screening exams are important. Occasionally a patient will complain about urinary symptoms such as urgency, frequency, slow flow or incomplete bladder emptying. However, these signs are much more commonly associated with benign prostate growth. While usually not related to prostate cancer, these symptoms warrant an evaluation by a urologist if they are severe or impacting your lifestyle.

Advanced prostate cancer symptoms may include bone pain, blood in the urine, weight loss, kidney failure or urinary retention.

What do you tell patients who are diagnosed with prostate cancer?

The first thing is that prostate cancer is treatable and usually curable if detected at an early stage. Second, most prostate cancer is fairly slow-growing, relative to other cancers. This gives patients time to consider the options and allows us to develop the best plan for their situation because the appropriate management really depends on the specifics of a patient’s case. Low-risk patients are often managed with surveillance alone, which allows us to monitor the disease without subjecting the patient to the potential side effects of treatment. Patients with more aggressive disease or those who are at higher risk find themselves in an era of evolving technology which has improved outcomes while minimizing side effects through robotic surgery, targeted radiation therapy and other treatments.

Patients in southeastern Connecticut and Rhode Island who are diagnosed with prostate and other urologic cancers also have access to the Prostate & Urologic Cancers Program throughout Yale New Haven Health’s Smilow Cancer Hospital Network. Yale Cancer Center’s designation as a Comprehensive Cancer Center by the National Cancer Institute enables them to offer patients advanced access to clinical trials.

Understanding prostate cancer can be overwhelming, but you’re not in it alone. Experts at Yale New Haven Health are ready to assist you in making your health a priority. Click here to learn more about the comprehensive, multidisciplinary clinic for patients with prostate and urologic cancers offered monthly at Yale New Haven Health.