Examinations

�The Prostrate Check

The first step in any medical checkup is a thorough medical history, including a family history. Your doctor will ask you questions about any past problems, treatments, or medical procedures and about any symptoms you are having, particularly problems with urination.

Early diagnosis of prostate cancer increases the chance of a cure.
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A physical examination is the second step. The prostate is an internal organ, so the physician cannot look at it directly. However, the doctor can feel the prostate by inserting a gloved, lubricated finger into the rectum. This simple procedure is called a digital rectal examination (DRE). This necessary examination allows the physician to estimate whether the prostate is enlarged or has lumps or areas of abnormal texture. While this examination may produce momentary discomfort, it causes neither damage nor severe pain. If the results of the digital rectal examination suggest that you may have a significant prostate problem, your doctor may refer you to a urologist. This is a doctor who specializes in diseases of the urinary tract and male reproductive system. The urologist may perform additional tests, including blood tests, urine tests, and/ or other diagnostic procedures, to determine the nature of your prostate problem. Prostate cancer also may spread (metastasize) to other parts of the body, such as the lymph nodes, the lungs, and the bones, especially the bones of the hip and lower back.

The PSA test detects the level of prostate specific antigen in the blood. PSA is a protein originally found in semen, the fluid that carries sperm. Normally, PSA is made in the epithelial cells of the prostate, which produce some of the semen that comes out of the penis at the time of sexual climax (orgasm). PSA is only made by prostate cells. Small amounts of the protein get into the circulatory system and can be measured in the blood. Certain prostate conditions, including cancer, can cause high levels of PSA in the blood. Once a small blood sample is taken, the level of PSA is measured by an accurate laboratory method called an immunoassay. Many factors can cause the PSA to rise, but PSA itself is harmless. The PSA blood test is used, along with the DRE, to find men who may need further testing. PSA cannot diagnose prostate cancer, however, only a biopsy can do that. The PSA test also is used to track the progress of men being treated for prostate cancer. If treatment is effective, the PSA should remain in the normal range. Improved methods of PSA testing are being developed. In the future, these may help your urologist decide whether the rise in PSA is due to prostate cancer or to a less serious problem.

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