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I dread getting a prostate exam. Is it really necessary?

The question: I'm a 44-year-old male and I'm nervous to see my doctor for fear of having the dreaded "finger test" to check my prostate. When is the right time to come in for this test and is it really necessary?

The answer: The "finger test" is also known as the digital rectal examination (DRE). You're not alone in dreading this procedure: Many of my male patients admit that the fear and discomfort of this test is the main reason they don't come in to see me.

Let's first break down what the prostate gland is and why it needs attention.

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The prostate is a spongy gland that sits below the bladder and in front of the rectum. It surrounds the urethra, the tube that carries urine from the bladder through the penis and out. The prostate produces semen, the fluid that nourishes and protects sperm.

As men age, the prostate gland grows in size. If the gland is overly enlarged or inflamed, it can lead to symptoms such as a change in urinary patterns (partial or full obstruction of urine flow) pain in the rectum, or fever. There are many conditions that can affect the prostate including a non-cancerous enlargement known as benign prostatic hyperplasia (the most common), inflammation of the prostate (prostatitis) and cancer.

There are two ways that we check the prostate, the DRE and a blood test called prostate specific antigen (PSA). During the DRE, your doctor inserts a lubricated gloved finger into the rectum to feel the size, shape and consistency of the prostate gland. The PSA is a protein in the prostate that can be elevated with any inflammation or enlargement of the prostate.

Prostate screening can help to detect potentially lethal cancer early. This sounds impressive, but it is important to consider that these tests are not specific to cancer alone, they have led to treatment of benign conditions or slow-growing cancers that may not have caused harm. The treatment for prostate cancer can have significant impact on quality of life due to potential complications such as pain, erectile dysfunction and urinary incontinence. Further to this, studies have shown that while screening with PSA and/or DRE has increased detection, they do not reduce death from prostate cancer. This is not meant to diminish the impact of prostate cancer, but it does highlight the need to understand that our currently available tests are not perfect and can sometimes do more harm than good.

For these reasons, before considering screening for prostate cancer as with any medical investigation, it is important to weigh the risks, benefits and potential harm.

To address this issue, in 2011 the Canadian Urological Association published their recommendation for prostate cancer screening. The CUA recommends that men should have a discussion with their family doctor to review what their risks are and the potential benefits and harms to screening. They recommend to offer prostate cancer screening to all men over the age of 50 who are low to average risk. If however you have risk factors such as a family history of prostate cancer or are African-American, the screening discussion should start earlier, at the age of 40. Remember, these guidelines are applicable to only those who do not have symptoms. If you have symptoms as mentioned above, testing should be done earlier regardless of age.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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