The dreaded DRE
It is recommended that starting at the age of 40, all men have this test performed once a year: the DRE or Digital Rectal Examination. In a nutshell, the doctor puts on a glove, lubes up then sticks a finger up your anus to feel up your nether regions, namely your prostate. It sounds more horrible than it actually is but it is certainly the butt of all sorts of comedic stories. The butt? Did I really just say that?
My story goes back a few years. I drop my drawers, bent over the table and the doctor proceeds to check my tonsils from the long way around. While he is doing this, he is asking me questions about skiing. It was quite a surreal moment to be comparing stories about the black diamond run on the northern face of Mont Tremblant with a man who has a finger inserted in my rectum.
The PSA Test
This is something which should be done once a year just like your DRE... BUT do not have the PSA test done right after your DRE. See my recommendations below.
This test is nothing more than a blood test and a couple of days may be necessary to get the results. Getting the test done the first time will give you and your doctor a base line from which all other tests will be compared. It is important to keep in mind that everybody is different so your baseline will be different from mine.
PSA stands for prostate-specific antigen which is a protein produced by the prostate gland and as a general rule of thumb, numbers under 4 are good. The number 4 refers to 4 ng/ml that is 4 nanograms per millilitre.
While traditionally doctors have looked at whether your score is over 4 or not, new interpretations of the score are looking at dramatic changes in the score as opposed to your actual baseline. All of us have different baselines and some people may have a "normal score" which is constantly over 4. The trick is when the score may change drastically like a spike from one year to the next. I have had years where the doctor had me back for a supplemental prostate test at the 6 month mark, not waiting a full year.
My important tips about this test
Since we are doing a test to determine if we have a cancer or not, it would be nice to ensure that we are not inadvertently affecting our PSA score. Things other than cancer can affect our prostate.
- Do not have an DRE then have a PSA test. Anything which physically interacts with the gland can cause the PSA to go up. It has been reported that riding a bicycle can affect the gland but this doesn't seem to be 100% conclusive. If you have an DRE, I would suggest you wait at least 48 hours before having blood drawn for the PSA test.
- Having sex and ejaculating can affect your PSA score. No sex for 48 hours before your test.
- Caffeine and alcohol may affect the prostate. Once again, abstain for 48 hours before the test. This may not be 100% conclusive but hey, would it hurt you to skip for a couple of days?
If the doctor suspects something, he may require you to undergo a prostate biopsy. Basically, an instrument is inserted in the rectum and a needle takes out about a dozen tissue samples which are then tested for cancer. You will see blood in your urine and your stools for several days afterwards and you may see blood in your ejaculate for a couple of weeks.
Okay, this isn't the most fun I've had in my life but I would call it a discomfort as opposed to outright pain. I ought to know; I have undergone 2 biopsies.
My story about the test
For 10 years my PSA test is consistently over 4. At one point I hit the 6 mark and my doctor sends me in for my first biopsy. It comes back negative.
I continue with my annual tests and I'm always over 4. Once again, I hit a high but this time I hit 6.9. What the hey? Biopsy number 2; it comes back negative.
This can't be right. I start researching on the Internet. I discover all sorts of references to the recommendations I listed above. My gawd, I realize my doctor has consistently over 10 years given me a DRE then sent me to have blood draw for my PSA test. Consistently.
I ask my doctor to do a special one off test. I've had no DRE for several months so for 48 hours before the test, no sex and no caffeine or booze. I go take my test and come in at 3.9, the lowest score I've had in over 10 years. Holy crap, I realize that what I'm reading on the Internet is true. Things other than cancer itself can cause the PSA to spike, especially the DRE which is actually touching and/or massaging the prostate.
Follow my recommendations: Before the blood test, no DRE, no sex, no caffeine and no booze for at least 48 hours before the blood is drawn!
You will thank me for this. Hell, I've had 2, count 'em two biopsies that probably were not necessary. I gotta tell ya that I was scared. Did I have prostate cancer? Was I going to bite the bullet? Was this the end of the line? Thank gawd, it turns out I'm as healthy as a horse. Okay, maybe I don't have the shiny coat that I was used to have but I'm still as healthy as one.
Did you know?
Massaging the prostate can be pleasurable for a man; the prostate has sometimes been referred to as the male g-spot. Such stimulation can make a man ejaculate faster and prostitutes have been well aware of this for years.
To all men: Don't be a wimp. Aren't you man enough to have somebody stick their finger up your where-the-sun-don't-shine? And when I say somebody, I am an equal opportunity patient and have waved my rights with two female doctors. A doctor is a doctor, female or not.
All men 40 and over should be undergoing these tests once a year. Getting it done earlier for a baseline wouldn't hurt. If you take care of your prostate; your prostate will take care of you.
According to my research, the new interpretation of PSA markers does not focus so much on the individual score but the change in scores. I have constantly come in higher than the traditionally acceptable score of 4, somewhere around 5. The conclusion is that this is "my normal". What the doctor is looking for is a dramatic change in the marker.
Wikipedia: Digital Rectal Examination
Wikipedia: Prostate-specific antigen
Wikipedia: Prostate Cancer
Wikipedia: Prostate Massage
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