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. 

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. 

Elevations of serum acid phosphatase have been reported in specimens obtained from patients after rectal examination (D4). However, Rou-brick and Winsten, in a study of 38 men, found that rectal examination performed on patients without known prostatic disease did not significantly elevate the serum acid phosphatase level (Rl). In patients with... 

Rl. Roubrick, M., and Winsten, S., Effect of routine rectal examination on the level of serum acid phosphatase. J. Urol. 88, 288-291 (1962). 

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. 

Rectal examination Rectal examination by way of inspection and palpation of the anus and rectum (especially after straining) is imperative. The presence of haemorrhoids should not be accepted as a potential source of bleeding without further diagnostic clarification. 

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. 

According to Dr. John H. Clarke, in his Dictionary of Materia Medica, homeopathic Silica and Pulsatilla are contraindicated in a patient taking saw palmetto, as they antidote the remedy. An early homeopathic physician, Elias C. Price, M.D., recorded several unusual case histories in which Serenoa was used. One patient was a very nervous woman with chronic inflammation of the bladder. She had frequent and painful urination, 10 to 20 times per night and every 15 to 30 minutes during the day. A rectal examination revealed a hard fleshy tumor the size of half a hen s egg on the posterior of the uterus. She was given Sabal (Serenoa) fluid extract, five drops, three times per day. In two months the tumor was reduced in size by half, and after another three months the tumor and the urinary problem were entirely resolved. In other cases. Dr. Price successfully used Sabal for pelvic cellulitis peritonitis puerperal fever inflammation of the uterus, fallopian tubes, and ovaries and even appendicitis. 

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)... 

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