Prostate Cancer Screening: Nothing to Fear
NEW YORK, NY--(Marketwired - Dec 27, 2013) - When it comes to prostate cancer screening, the prostate-specific antigen (PSA) test is only the beginning. This routine blood test is used to assess the stability of a man's PSA level and the potential presence of prostate cancer. But the PSA alone is not enough. When paired with a simple physical exam, the digital rectal exam (DRE), much more can be learned about a man's prostate health. Unfortunately, it's a step some men shy away from.
David B. Samadi, MD, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital, is committed to helping men see the importance, ease, and safety of prostate cancer diagnostics. Last month, TODAY show hosts, Matt Lauer and Al Roker, invited Dr. Samadi to conduct their prostate cancer DREs on air, behind closed doors, demonstrating just how quick and painless the test really is.
"In less than a minute, the DRE gives me a surprising amount of information about a man's prostate. If Matt and Al could undergo a 34-second exam on TV, surely other men can do the same in the privacy of my office," said Dr. Samadi.
A digital rectal exam is just as it sounds. Using a gloved finger, the doctor feels for irregularities, lumps, or hardened areas of the prostate. While the exam is hardly something men look forward to, research suggests that the DRE may be just as important as the PSA test, if not more so.
A 2012 Penn State College of Medicine
study demonstrated the efficacy of the DRE in detecting prostate cancer tumors. Among the prostate cancers diagnosed in study participants, 31 percent were caught during the DRE, not from the PSA blood test.
Prostate biopsy and infection risk
Combined, PSA test results and the DRE provide a wealth of information. When needed, the next step in prostate cancer diagnosis is a prostate biopsy. The needle biopsy is used to officially diagnose the presence of prostate cancer cells and determine their severity. After microscopic analysis of the prostate tissue, a Gleason score is assigned to quantify disease type and aggressiveness.
During an in-office prostate biopsy, tissue samples are gathered using a fine needle to guide an ultrasound probe through the rectum wall into the prostate gland. Alternately, the needle may also be inserted through the perineum, the area of skin between the rectum and the scrotum. A numbing gel is used at the site of needle insertion, making the procedure less daunting than it seems. Slight discomfort may be felt in the days following the biopsy.
Like the PSA test, the prostate biopsy is not without controversy. Some experts caution that performing the procedure via the rectum can introduce rectal bacteria into the prostate and lead to infection. Others, like Dr. Samadi, believe that the test is safe and necessary. Prophylactic medications are used before and after the biopsy to prevent infection, and pre-biopsy swabs flag any antibiotic-resistant bacteria.
"The goal of the biopsy is to rule out or define the cancer," said Dr. Samadi. "It's our only definitive prostate cancer test and we make treatment recommendations and act according to what we learn. This information is safe to obtain and too important to forgo."
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