Examination of the prostate

introduction

The prostate - in German the prostate gland - is a man's organ that produces a secretion that is secreted into the urethra during ejaculation and then mixes with the sperm.
The secretion of the prostate makes up about 30% of the ejaculate.

The prostate lies under the urinary bladder and surrounds the urethra. Right behind her is the rectum (the Rectum).

A simple method of examination of the prostate is the so-called digital (from Latin: digitus - fingers) rectal (over the rectum) examination (DRU). The doctor can feel the prostate and check its size and consistency.

As part of cancer screening, the prostate can be examined regularly from the age of 45.

If images of the prostate are required, an MRI of the prostate is an option.

Read more about this topic here: Prostate cancer screening: when? For whom? Procedure!

General

When and why will a digital rectal exam be performed on the prostate?

The target this investigation is on the one hand the Early detection of Prostate cancer - the most common cancer in men, as well as the assessment of one Increase in size as part of a benign growth (benign prostatic hyperplasia), but also the Assessment of the rectal mucosa to detect rectal cancer.

In women the rectal examination is used to assess the Back of the uterus and the space between the uterus and rectum, the so-called Douglas room.

The prostate is an organ that is under the Influence of testosterone is working. The sex hormone stimulates the 30 to 50 individual glands the prostate to that Prostate secretion to build. This secretion contains, among other things, enzymes that are important for the Mobility and fertility of sperm are.

Especially in older men it comes to one relatively often excessive growth the prostate. If this growth is benign, one speaks of a benign prostatic hyperplasia (BPH). Since the enlarged gland often presses on the urethra that surrounds it, urinary diversion disorders can occur. The enlarged prostate then often fails Problems urinating (Dripping, frequent need to urinate).

At a Prostate cancer it is a malignant growth. This means that the prostate tissue can grow into the surrounding tissue and is often from hard and irregular consistency.
Most prostate carcinomas arise in the outer zone, which makes them larger than a certain size palpable from the rectum are.
Prostate cancer is that most common cancer in men with a mean age of onset of 69 years.

execution

The rectal examination can be performed in three different body positions of the patient.

Most of the time the patient lies in Left lateral position with your legs slightly drawn up on the examination table, with your buttocks as close as possible to the edge of the table.
Other possible positions are that Knee-elbow position on the couch or in stand (However, this situation is often perceived as very uncomfortable) or the Lithotomy position on the gynecological examination chair, while the doctor can feel the stomach with his left hand at the same time.

After the doctor puts on gloves, inspected he first the dam region. For example, he looks for redness, cracks or signs of infection of the anal mucosa and hemorrhoids (around 70% of those over 30 years old suffer from these, but most of them are symptom-free).

Next leads the doctor smeared the petroleum jelly Finger in the anuswhereby he pays attention to the tone, i.e. the muscle strength of the sphincter muscles.
If the pressure of the finger on the rectum hurts, it can be for you inflammatory process speak in the area of ​​the appendix (see: appendicitis) or - in women - the ovaries, fallopian tubes or the space between the uterus and rectum (Douglas space).

In approx. 7-8 cm depth can the doctor in men the prostate feel. With the Palpation he can assess the size, consistency, mobility of the mucous membrane and its delimitation from the surrounding tissue.
The size a chestnut that consistency a tense ball of the thumb and a good one palpable furrow in the middle would correspond to the normal findings.
Is the prostate pressure painful, this speaks for an acute or chronic inflammation.

After the examination the doctor pays attention to remains of stool, mucus, blood or pus on the finger cot. Based on the color of the blood or stool, he can distinguish gastrointestinal bleeding from haemorrhoidal bleeding, because bleeding in the stomach or intestinal tract is when the blood is excreted already black or stains the chair dark.
Bleeding from hemorrhoids will show through fresh, light blood.
Remnants of stool can still be used for a haemoccult test, which is used to diagnose colon cancer.

Finally, the patient is offered cloths to clean the petroleum jelly.

A useful investigation?

With the digital rectal examination, both benign and malignant changes in the prostate can be discovered through an uncomplicated and quick examination.
Likewise colon carcinomas, 20-30% of which arise in the area accessible with the palpable finger.

The examination does not involve any risks for the patient. So that the above-mentioned changes in the prostate can be detected at the earliest possible stage, in which the prognosis for treatment is significantly better than in later stages, it is recommended that men from the age of 45 have regular examinations once a year.
Men who have an increased risk of developing prostate cancer due to previous family illnesses, for example, can be examined from the age of 40.

The sensitivity of the DRU - so the probability that a sick person is actually recognized as sick by the examination - is about 60%.
The specificity - the probability that healthy people will also be recognized as healthy by the test - is around 75%. So the investigation is not entirely reliable.

There are controversial assessments about the usefulness of the investigation.
The informative value of the examination is limited because it can only detect superficial tumors above a certain size on the side facing the intestine. In addition, the result is strongly dependent on the examiner. Therefore, the rectal examination is not sufficient as the sole early diagnosis examination.

Another option is to determine the PSA level in the blood.
The prostate specific antigen is an enzyme that is formed in the prostate and which can be increased in the presence of a carcinoma, which is why the value is used as a tumor marker.

The PSA determination is primarily used to monitor the progress of existing prostate cancer. 48 hours before the test, the patient should avoid pressure on the prostate through cycling, horse riding, competitive sports, sexual intercourse, as well as aspirin or other blood-thinning medication in order not to affect the value.
The PSA value can also be increased in the case of inflammation of the prostate or benign prostate adenomas. Clarification should be carried out for values ​​above 4 ng / ml.

Another examination of the prostate is the transrectal ultrasound examination. Here the ultrasound head is inserted rectally, whereby suspicious areas of the prostate can be visualized.

The statutory early detection program for men over 45 years of age provides for an examination of the prostate by means of a rectal examination and the genitals by palpation of the testicles and the lymph nodes in the groin. However, the PSA determination is not included.
This test is controversial because it is not clear whether men really live better or longer by regularly measuring the PSA value.

If the rectal examination reveals changes in the prostate, further more specific examinations can follow, for example a sample of the tissue (Prostate biopsy), a colonoscopy or the PSA test, which would now also be covered by the health insurance company because of suspected changes in the tissue.

Tissue extraction is the only way to reliably determine or exclude a carcinoma.
With a fine needle, ultrasonically controlled, several tissue samples are taken from the rectum and then checked for cancer cells under the microscope.

Which doctor?

The examination of the prostate is usually done by the attending family doctor or by a urologist.

The rectal exam can be uncomfortable or embarrassing, but it is usually not painful.

Are there tears in the anal mucosa or is the prostate inflamed (Prostatitis) the rectal exam can be irritating or painful.
For the general practitioner, it is a routine examination that is carried out with particular care.

Read more on this topic at: The urologist

costs

The regular cancer check-up for men, which includes palpating the lymph nodes in the groin and genitals, checking the complexion and performing a rectal examination of the prostate and rectum, costs around 30 euros.
The health insurance company pays these costs once a year from the age of 45.

The cost of the PPE determination is between 15 and 45 euros.
You will not be covered by health insurance as part of a preventive medical check-up.

However, if prostate cancer is suspected, the test is used to monitor the course of the treatment of prostate cancer or benign prostate hyperplasia or for follow-up care after therapy, the costs will be reimbursed by the health insurance company.

The cost of the transrectal ultrasound examination is around 40 euros. The health insurances usually only cover the costs if a carcinoma is suspected.

You might also be interested in: PSA value