Do You Really Need a Prostate Exam?

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 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 signs/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 have access to the Prostate & Urologic Cancers Program throughout the Smilow Cancer Hospital Network. Yale Cancer Center’s designation as a National Cancer Institute Comprehensive Cancer Center brings the most advanced access to clinical trials to our patients throughout the entire network.

  As part of the program, Smilow Cancer Hospital offers a comprehensive, multidisciplinary clinic for patients with prostate and urologic cancers at the Smilow Cancer Hospital Care Center in Waterford. The clinic enables patients to meet simultaneously with multiple Smilow Cancer Hospital specialists, including a urologist, radiation oncologist, medical oncologist, advanced practice providers, and social workers. This team approach provides newly diagnosed patients with a carefully determined, personalized treatment plan focused on providing the most comprehensive, effective care possible. The clinic is available monthly at the Smilow Cancer Hospital Care Center, 230 Waterford Parkway South, Waterford. For appointments, call 860-271-4652.

• What other health issues should men be aware of in “Movember” besides prostate cancer?

  While Movember started as a prostate cancer awareness movement during the month of November, it has turned into so much more. Men’s health has become an important buzzword that includes both physical and mental health. It’s also important that men — and those who love and care about them — consider other health issues including low testosterone (low T), erectile dysfunction (ED) and fertility. Men may be reluctant to discuss these issues but addressing them may reveal silent health concerns. Erectile dysfunction may indicate a heart condition; low T can be associated with depression.

  That’s why men should make an appointment with their primary care provider. During the visit, the provider will check blood pressure, record weight, and may order blood tests to review cholesterol, blood sugar and other levels that could indicate urological, cardiac and endocrine conditions. Excessive weight is a concern, because it is often related to degenerative, arthritic changes in men, especially in their hips and knees.

Good health should be a year-round concern for men – not just in November. This time of the year should be a time for men to reflect on things in their life that they can change to impact their overall health for the better.

Talk to your doctor. If you don’t have one, call 833-346-3637 or visit Find a Doctor for a referral to a primary care physician near you.