The dreaded prostate exam

I'll be honest with you, I find the phrase “Bend over and drop your pants” disturbing in the vast majority of scenarios I can think of. While I understand that it may hold considerable appeal for many men with different sexual proclivities than my own, it just doesn’t do it for me. And so the thought of going for my first ever prostate exam doesn’t exactly fill me with joy and excitement.

Necessary evil

I've recently turned 40 though and I’m becoming increasingly aware of my body's growing age and frailty. Ok, that sounds entirely too melodramatic. What I meant to say is that I’m more and more conscious of the need to have my body checked out by a trained professional on a regular basis. Most of us guys are completely anal (excuse the pun, but I just couldn’t help myself) about having our cars serviced frequently. It’s the same with our own physical equipment - ideally it needs to be inspected by a doctor once a year.

The prostate gland, that walnut-sized organ tucked away in your nether regions, is definitely one of the body parts that needs regular medical attention, but seldom gets it. The inconvenience, of course, is that it can only really be accessed properly via your back door.

There are several things that can go wrong with your prostate. It can get inflamed or enlarged, but the biggest potential problem is prostate cancer, one of the most common forms of cancer in men and a significant killer, especially of older men. Many celebrities, including Nelson Mandela, Desmond Tutu, Robert De Niro, James Brown and Roger Moore have suffered from and survived the disease, while others who left it too late, among them Pablo Neruda, Telly “Kojak” Savalas, Frank Zappa and Johnny Ramone, succumbed to it.

So while the thought of someone “probing” your rectum may fill you with fear and loathing, having your prostate checked out annually may just save your butt! To make the experience a little more bearable, we've put together some information about what you can expect from a prostate exam.

The finger wave

There are several tests that are routinely carried out to assess prostate health, but the most common and notorious is the digital rectal exam or DRE and every fifty year old man is advised to have one at least once a year.

The “digital” in "digital rectal exam" doesn’t refer to the fancy computer equipment your doctor will be using, but to the fact that s/he will palpate the prostate with one of his or her digits (most likely his or her index finger) to check for size, symmetry (a healthy prostate consists of two equal halves, separated by a narrow groove), lumps, firmness (which should be similar to that of the tip of your nose) and texture.

Here’s what happens during a typical DRE:

• You’ll be asked to stand with your feet apart and bend forward so that your arms or elbows rest on a desk or examination couch. Alternatively, the exam may be conducted while you’re lying on your side with your knees bent towards the chest.

• The doctor will wear a surgical rubber glove with a heavily lubricated finger and will warn you when s/he is about to insert it into your rectum. Expect to feel a little pressure, but only mild discomfort.

• The finger will be inserted at a downward angle as if pointing to your bellybutton and the doctor will give your sphincter a few second to relax.

• The doctor will move his/her finger in a circular motion while gently feeling the prostate.

• The doctor will probably tell you when s/he is about to retract the finger and use a tissue to wipe the lubricant off your anus and buttocks.

• Expect the whole procedure to take about a minute or less.

Have a look at this video clip in which Doctor Gerald Chodak takes you through what you can expect during a prostate exam:

Come prepared

You can make the experience more comfortable for everyone involved by:

• having a bowel movement, which some reckon reduces the pressure you’re likely to feel during the examination, and thorough shower beforehand;

• letting your doctor know if you have haemorrhoids;

• trying to relax before and during the examination; and

• taking a deep breath as the finger is being inserted.

The DIY option

It is possible to do a prostate self-exam, but most doctors seem to think it’s a bit of a waste of time, because you don't really know what you're looking for. Besides, unless you have abnormally long fingers and double-jointed wrists, elbows and shoulders, you’re probably going to struggle to reach the right spot. If you have that kind of relationship, you can of course ask your partner for a helping hand. Should you decide to try this, clipped fingernails are a must, but your self-exam should not take the place of a professionally-administered DRE.

Other tests

There are several other prostate tests that your doctor may recommend:

• A PSA blood test, measures the levels of prostate specific antigen, one of the compounds produced by the prostate, in your blood. Elevated levels may indicate prostate infection, enlargement or cancer.

• A urine test will check for the presence of blood, infection or abnormal cells in your urine.

• A urine flow rate test may indicate a slow rate of urination which may be linked to prostate cancer.

• During a transrectal ultrasound, a probe that resembles a small microphone is inserted into the rectum. It emits high-frequency sound waves and listens to the returning echo to create a picture or sonogram of the prostrate, a bit like the sonar equipment used by ships and submarines.

• If any of the tests suggest that you may have prostate cancer, your doctor is likely to recommend a prostate biopsy, during which a sample of prostate tissue is examined under a microscope. It’s is the only method that can give definite confirmation of prostate cancer.

More prostate info:

• The lowdown on the prostate

• Prostate resources

• Prostate cancer

• The Health24 prostate health centre

(Andreas Späth, Health24, November 2009)

Join the Movember Movement! There's still time to catch up with Andreas and other moustachioed comrades who're growing their mo's this November in the fight against prostate and testicular cancer.