Doctors give themselves regular prostate exams

Examination of the prostate

The aim of the prostate examination by the urologist is to detect benign and malignant diseases of the prostate at an early stage.

Short version:

  • The prostate is a secretion-producing gland that surrounds the urethra and is located in close proximity to the rectum.
  • With the help of the prostate examination, benign and malignant changes in the prostate can be detected at an early stage.
  • Common examination methods are palpation, determination of the PSA value and ultrasound.
  • If cancer is suspected, a tissue sample is taken and an MRI is performed to establish the diagnosis.
  • The advantages and disadvantages of a prostate examination are best discussed with the treating urologist.

What is the function of the prostate?

The prostate gland is a gland weighing around 20 grams in adult men, the size and shape of which is often compared to that of a chestnut. It is located directly under the urinary bladder and in close proximity to the rectum. The urethra runs right through the middle of the prostate so that an enlarged prostate gland can obstruct the flow of urine. In addition, the two vas deferens run through the gland and open into the urethra in this area. The prostate also has several ducts into the urethra through which it releases the secretion it has formed during ejaculation.

The prostate secretion contains numerous protein bodies (enzymes) that are essential for the sperm cells to function. Without the prostate secretions, the sperm cells would not be able to reach the female egg. One of those enzymes is that Prostate Specific Antigen (PSA), which plays a decisive role in prostate diagnostics. By contracting muscles, the prostate is able to narrow or widen the urethra. This ensures that either urine or ejaculate, but never both, passes through the urethra at the same time. The function of the prostate is primarily regulated by the male sex hormone testosterone.

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What is the purpose of the prostate examination?

In the course of the prostate examination, pathological changes should be detected early. A basic medical distinction is made between benign and malignant changes, with benign being by far the more common. A benign enlargement of the prostate (benign prostatic hyperplasia) can be observed in around 50 percent of all 60-year-old men, and in 90-year-olds it is even 90 percent. Among the most important benign changes counting:

However, the real reason for a prostate exam is to exclude one vicious change (Prostate cancer). Prostate cancer is the most common cancer in men and accounts for around a quarter of all cancers. The cancer usually occurs between the ages of 50 and 70 and often goes undetected for a long time. Many men avoid going to the urologist, even if they are already suffering from symptoms of a prostate change. These include, for example:

  • Problems urinating
  • a weakened stream of urine
  • trickle down
  • frequent visits to the toilet (especially at night)

In addition, the symptoms are often hidden and taboo for far too long out of a feeling of shame. The aim of many national and international professional societies is to anchor regular urological early detection in men as a natural contribution to maintaining their own health, as has already been achieved with many women with regard to early breast cancer detection.

+++ More on the topic: How is prostate cancer diagnosed +++

How is the prostate examined?

Men are supposed to once a year from the age of 45 Have a urologist examined so that changes in the prostate can be discovered as early as possible (prostate examination). The basic examination of the prostate usually consists of a rectal palpation examination, a residual urine measurement using a lower abdominal ultrasound and a PSA determination.

The palpation examination

The palpation exam examines the consistency and shape of the prostate for changes. A hardening or an irregular surface can indicate a tumor. The doctor makes use of the proximity of the prostate to the rectum by feeling it with his finger from the rectum. The examination itself does not take long and is usually completely painless.

The PSA regulation

In addition to the rectal palpation examination, the determination of the PSA concentration in the blood can be carried out as part of the prostate examination. The PSA is determined if the prostate is enlarged or to monitor the progress of an inflammation or a tumor. The concentration is usually given in micrograms per liter (µg / l). In general, the higher the PSA value, the higher the likelihood that a benign or malignant disease is present.

Although the PSA value is very specific for the prostate, it can be influenced by a number of factors, which limits its informative value. These include:

For this reason, a regular PSA determination is recommended, as the course of the PSA values ​​is much more meaningful than a single measured value. No prostate cancer is found in three out of four men with initially elevated PSA levels.

+++ More on the subject: PSA test +++

Multiparametric MRI of the prostate

If a change in the prostate gland is suspected in the course of a palpation examination and PSA determination, the urologist will order an MRI of the prostate for a more detailed clarification. There are so-called PIRADS criteria determines the likelihood of prostate cancer being present.

Although there are numerous criteria by which the specialist assesses changes in the prostate, none of the examination methods mentioned can diagnose prostate cancer with absolute certainty. This is only done with the help of a tissue sample (biopsy).

The tissue sample

In order to be able to clearly classify altered glandular tissue and to confirm or refute a suspicion of cancer, it is necessary to obtain tissue samples from the prostate. For this purpose, tiny tissue cylinders are punched from various areas of the prostate gland with the help of thin needles (punch biopsy).

These cylinders are then examined for degenerate cells under the microscope. This is the only way to clearly identify or exclude a carcinoma. The biopsy of the prostate is usually also carried out via the rectum and is monitored using ultrasound.

Before the biopsy, the patient is given an antibiotic to prevent infections (antibiotic prophylaxis). An enema can be given to prepare and cleanse the colon. So that the actual puncture through the biopsy needles is as painless as possible, lubricants with local anesthetics are usually used. After the prostate biopsy, in up to 60 percent of cases, there may be temporarily harmless blood in the urine or ejaculate. Serious infections are rarely observed due to the preventive use of antibiotics.

+++ More on the subject: biopsy +++

Advantages and disadvantages of early detection

advantages early detection are:

  • better chance of recovery
  • fewer metastases
  • gentler surgical procedure
  • fewer undesirable side effects of therapy

disadvantage early detection are:

  • Diagnosis of prostate cancer not requiring treatment (overdiagnosis)
  • subjective feeling of being sick, although one actually has no complaints
  • recognized early and still not curable (particularly aggressive tumors)

The advantages and disadvantages of early detection are best discussed directly with the urologist.

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Authors:
Dr. med. Christoph Weiss (first author), Mag. (FH) Axel Beer (2016), Christopher Waxenegger (2021)
Medical review:
Dr. Erik Randall Huber
Editorial editing:
Thomas Auinger, Astrid Leitner (2021)

Status of medical information:
swell

Oncology Guideline Program. Interdisciplinary guideline of quality S3 for early detection, diagnosis and therapy of the different stages of prostate cancer, status 2019 (last accessed on December 6th, 2020)

Ilic D, Djulbegovic M, Jung JH, et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ. 2018; 362: k3519.

Andriole, Gerald et al: Mortality Results from a Randomized Prostate-Cancer Screening Trial. In: New England Journal of Medicine (2009), H. 360, pp. 1310-1319.

Botchorishvili G, Matikainen MP, Lilja H .: Early prostate-specific antigen changes and the diagnosis and prognosis of prostate cancer. In: Curr Opin Urol. 2009 Mar 21.
Jocham, Dieter / Miller, Kurt (Hrsg): Practice of urology. Stuttgart: Thieme 2003.

Lee, Thomas / Kantoff, Philip / McNaughton-Collins, Mary: Screening for Prostate Cancer. In: New England Journal of Medicine (2009), H. 360, p. E18.

Austrian Society for Urology and Andrology - www.uro.at/ (as of 1.5.2009)

Schröder, Fritz et al: Screening and Prostate-Cancer Mortality in a Randomized European Study. In: New England Journal of Medicine (2009), H. 360, pp. 1320-1328.

Statistics Austria - www.statistik.at (as of 1.5.2009)

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