Prostate cancer digital rectal examination

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. 

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. 

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... 

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. 

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. 

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