At first we should ask ourselves the question: “Why is a prostate self-exam necessary?” Most men are reluctant to go to the doctor. We know that the digital rectal exam (DRE) can discourage some men from seeking preventive medical checkups. The evidence, which is pretty conclusive at this point, is that whenever a hospital or clinic offers free prostate cancer screenings that include both the prostate specific antigen (PSA) blood test and the DRE, the participation rates of the members of the surrounding communities are minors. always much lower than if the PSA blood test is offered alone. So many more men will participate if only the PSA is offered.
Instead of pestering these men to “become men” and endure a test that is humiliating for them, we can offer them an alternative. While some are skeptical of the value of prostate self-exams, the fact remains that these skeptics have no alternative to suggest other than prompting men to have prostate exams with their doctors.
Prostate self-exams will be more valuable and effective when men are educated on how to perform these self-exams. Men should learn to perform prostate exams by watching videos, available on the Internet, in which doctors demonstrate the technique. They also need to see dozens of diagrams of the prostate to know what to expect when they do the self-exam.
We already encourage all men, but especially those between the ages of 15 and 35, to do a monthly testicular self-exam. If men can examine their own testicles, then they are likely to be mature enough and capable of examining their prostate once they learn how to do it and gain some experience examining their own prostates.
Men sometimes think that a doctor inserts a finger and then directly touches the prostate. That perception is not correct. The finger (or finger) is inserted through the rectum, but the finger is located within the intestine, which is separate and distinct from the prostate gland. Essentially, the doctor, or the patient in the case of self-examination, is pressing down on the wall of the intestine in order to feel the posterior surface of the prostate gland under the wall of the intestine. However, the wall of the intestine effectively protects the prostate, so any suspicious nodules or areas must be large enough to be palpable through this cushion. Ideally, the examiner would like to be able to touch the surface of the prostate directly, but has to make a close substitute for feeling it through the wall of the intestine.
Topics to remember
A normal prostate is the size of a walnut. The prostates can enlarge to the size of a lemon. Possible causes of an enlarged prostate include benign prostatic hyperplasia or hormonal imbalance (too much estradiol or dihydrotestosterone) or prostatitis. As men age, they enter a period that we call Andropause; it is analogous to menopause in women. During andropause, which normally lasts until the end of a man’s life, the body produces very little testosterone, resulting in an imbalance between testosterone and estrogen.
Estrogen levels in men are measured through the serum estradiol level. Both estradiol and dihydrotestosterone, the powerful form of testosterone, can irritate and cause an enlarged prostate. Elevated levels of estradiol have been shown in clinical studies to cause prostate cancer; while dihydrotestosterone is known to accelerate the growth of prostate cancer, but it does not appear to cause cancer on its own. A third explanation for why the prostate might enlarge is if the patient has prostatitis.
The prostate feels similar to the pulp of an orange cut in half. If you feel something hard like the seed of an orange against the softer pulp, that would be a suspected area for prostate cancer.
Important points to remember
For the prostate self-exam, the finger should be inserted into the rectum with the palm of the hand facing down and the nail of the index finger on top. It will feel much more natural, especially the first time you try, insert your finger palm up and nail down. If you were to clean yourself with a bar of soap, you would naturally hold the soap with the palm of your hand facing up and your fingernails pointing downward. But you will have to learn to turn your hand and make the palm of your hand face down and the nail up, so that you can feel the prostate with your fingertip and not your nail. You will feel uncomfortable for at least the first five times you try to insert your finger in the correct position.
The prostate is not the round shape of a walnut, but rather appears more like the top of a heart-shaped object. Most men will find that they have a left lobe, a median lobe over which the urethra passes and effectively bisects the prostate, and a right lobe. With a little practice, you will be able to tell which lobe you are touching and any small differences between the lobes.
When you do your prostate self-exam at home, you will need to lean forward so that the prostate sticks out and can be felt more easily. If you stand up, your prostate will point downward (in the direction of your legs) and it will be more difficult to feel with the digital rectal exam.
Get a more complete prostate exam than you are likely to get from a family doctor. Go over each available surface of the prostate at least three times and with different circular motions each time. In the privacy of your own home, take at least a full minute and preferably two minutes to examine your prostate. Its goal is to be able to detect any cancerous node (hard surface) the size of a grain of rice. You won’t be able to feel a suspicious node in that degree of detail with a flick of your finger once over the prostate.
So when you visit the family doctor’s office, and the doctor inserts a finger and moves it quickly over the prostate, with complete control in three or four seconds, that is not a detailed exam of the prostate. Something that superficially could not detect a cancer the size of a grain of rice. And that is your goal; their goal is always early detection, while any prostate cancer is still small.
Do not attempt a prostate self-exam if you are unwilling to take the time to learn how to examine the prostate by reviewing clinical practice guidelines available on the Internet. Your health is at risk; Trust yourself only if you have the intellectual capacity to distinguish between normal and abnormal surfaces in soft tissues such as the prostate. If you think that you will not be able to distinguish between normal and abnormal surfaces, you should not attempt this check yourself.
Prostate Self-Exam Benefits
The patient can check the prostate more regularly than once a year (early detection leads to earlier diagnosis and treatment). You can check your prostate quarterly or as often as you like given the state of your prostate, but you don’t have to limit yourself to an annual checkup.
Second, self-educating men to learn how to do a prostate self-exam can avoid the discomfort and embarrassment that men often associate with digital rectal exams. Third, men can visit the doctor more often without worrying about being asked to have a DRE or prostate exam at each visit.
The interested reader should watch the instructional video associated with this article. The video can be found at http://www.michaelguth.com/?p=1155