Rectal examination, digital

Transrectal prostate needle biopsy to be done if the patient has areas of nodularity or induration on digital rectal examination tissue biopsy can document the presence of prostate cancer, which can also cause enlargement of the prostate... 

Digital rectal examination Procedure in which the health care professional inserts a gloved finger into the rectum to examine the rectum and the prostate gland for signs of cancer. 

Increased diagnosis of prostate cancer is attributed in part to the increased utilization of PSA testing. In fact, the American Cancer Society (ACS) now recommends measurement of PSA in addition to digital rectal examinations (DREs) in men over 50 years of age. Early detection of clinically localized prostate cancer can potentially result in a cure with radical prostatectomy or other treatments. PSA tests are used to monitor therapeutic efficacy and detect recurrent disease in patients with prostate cancer. 

On digital rectal examination, the prostate is usually, but not always, enlarged (more than 20 g), soft, smooth, and symmetric. 

Laboratory tests (e.g., blood urea nitrogen, creatinine, PSA) and urinalysis should be monitored regularly. In addition, patients should have an annual digital rectal examination. 

Monitoring Monitor patients with BPH for prostate cancer (eg, digital rectal examinations) prior to initiating therapy and periodically thereafter. Monitor for obstructive uropathy in patients with large residual urinary volume and/or severely diminished urinary flow. 

Objective measures of bladder emptying (e.g., uroflowmeter and postvoid residual urine volumes) are also useM after 6 to 12 months of 5a-reductase inhibitor therapy or 3 to 4 weeks of a-adrenergic antagonist therapy. Laboratory tests (e.g., blood urea nitrogen, creatinine, PSA) and urinalysis should be monitored regularly. In addition, patients should have an annual digital rectal examination. 

Treating prostate cancer in its early stage should be an effective means of achieving long-term survival. However, the non-invasive diagnostic tests currently available, i.e. digital rectal examination, transrectal ultrasound, and... 

The odds ratio is defined as the probability of the presence of a specific disease divided by the probability of its absence. The odds ratio reflects the prevalence of the disease in a population. For example, the probability of the occurrence of a 1.3-cm carcinoma in a 75-yeai -old man is about 8%. The odds ratio of finding histological carcinoma greater than 1.3 cm in size after sectioning the prostate from the autopsy specimen of a man older than 70 years is thus 0.08/(1-0.08), or 1 11.5. Findings from a digital rectal examination, from transrectal ultrasonography, or firom both are other data that affect the previous probability of the presence of prostatic disease. 

The metabolic clearance rate of PSA follows a two-compartment model with initial half-lives of 1.2 and 0.75 hours for free PSA and total PSA and subsequent half-lives of 22 and 33 hours. Because of this relatively long half-life, 2 to 3 weeks may be necessary for the serum PSA to return to baseline levels after certain procedures, including transrectal biopsy, transrectal ultrasonography, transurethral resection of the prostate, and radical prostatectomy. Prostatitis and acute urinary retention can also elevate PSA concentration. Although the digital rectal examination has no clinically important effects on serum PSA levels in most patients, in some it may lead to a twofold elevation. 

Radiation Therapy. The role of PSA in the monitoring of patients after definitive radiation therapy is less well defined as compared with that after radical prostatectomy. The majority of patients show an initial decrease of PSA level after radiation therapy. PSA is better than digital rectal examination for detecting residual cancer after radiation therapy. 

Pinne P> Auvinen A, Aro J, et al. Estimation of prostate cancer risk on the basis of total and fi ee prostate-specific antigen, prostate volume and digital rectal examination. Eur Urol 2002 4I(6) 619-26. 

Round, soft, symmetric, and mobile on palpation, a normal prostate gland in an adult man weighs 4 to 20 g. Physical examination of the prostate must be done by digital rectal examination (i.e., the prostate is manually palpated by inserting a finger into the rectum). Thus the prostate is examined through the rectal mucosa. 

Digital rectal examination reveals an enlarged prostate... 

At each return visit, the patient should complete a standardized, validated survey tool to assess severity of symptoms. A digital rectal examination, urinary flow rate, postvoid residual urine volume, and routine laboratory tests (BUN and serum creatinine)... 

Normal doses of 5a-reductase inhibitors reduce serum PSA levels by 50%. For this reason, PSA levels must be measured before treatment begins, and the patient should have a digital rectal examination. After 6 months of therapy, the patient should have a repeat PSA. If the level does not decline by 50% and the patient has been adherent to the 5a-reductase inhibitor regimen, he should be evaluated for prostate cancer. Annually thereafter, the patient should have a PSA assay and digital rectal examination, and patients with any rise in PSA levels should be evaluated for prostate cancer. To interpret a PSA level in a patient being treated with a 5a-reductase inhibitor, it is generally recommended that the actual measured level be doubled to get an estimate of the true level. 

Key laboratory tests to monitor on an ongoing basis are serum BUN and creatinine and urinalysis. Because this patient population is at high risk for prostate cancer, PSA should be measured and a digital rectal examination performed annually. For patients taking 5a-reductase inhibitors, PSA must be compared with baseline and 6-month responses, as described in the section on 5a-reductase inhibitor. 

In both sexes, digital rectal examination provides an opportunity to check ambient rectal tone, the integrity of the sacral reflex arc (e.g., anal wink), as well as assess the patient s ability to perform a voluntary pelvic floor muscle contraction (i.e., Kegel exercise), which may be an important factor in deciding on appropriate therapy. In men, a digital examination of the prostate assesses for the presence of prostate cancer, inflammation, and BPH. 

The digital rectal examination has been a traditional part of the annual physical examination in patients older than 40 years of age and accounts for the detection of about 10% of all colorectal cancers that are within 7 to 10 cm of the anus. By itself, the digital rectal... 

Digital rectal examination should be done at the time of each sigmoidoscopy, colonoscopy, or DCBE. 

Digital rectal examination (DRE) Prostate-specific antigen (PSA) Transrectal ultrasonography (TRUS) if either DRE is positive or PSA is elevated Biopsy... 

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