Your choices in prostate testing & the dreaded finger.
Let’s not beat around the bush – a lot of men are concerned about discussing prostate symptoms with their doctor because they think it automatically means one thing… a finger up the bum. What you might not realise is that you do actually have a say in what tests and examinations you undergo – the NHS is increasingly working to incorporate the patient in conversations and decisions about the care that they receive, and that includes investigations of the prostate.
We’re going to break down the different types of tests you might be offered if you’ve noticed some prostate symptoms and the choices that you have to inform your own care.
Despite what you might have heard, prostate testing has actually evolved significantly over the past few years.
The ways in which prostate symptoms were investigated 10 years ago were significantly different, so if you’re worried about going to the doctor because your mate told you about their experience a few years back, chances are that it won’t be the same anymore.
The old way versus the new way...
The DRE (finger up the bum)
The acronym used for the finger up the bum test is a DRE – Digital Rectal Examination. It used to be performed more commonly, and honestly it does serve a purpose. The DRE allows a doctor to check the size, shape and texture of the prostate. A healthy prostate is typically similar in size to a walnut during a DRE, so if a doctor notices anything different it can be a quick and easy way of checking if anything seems out of the ordinary. That being said, it is only one part of a wider assessment used to investigate prostate disease and isn’t always necessary. If fear of the unknown when it comes to the DRE bothers you, let’s quickly go over what it entails…
A DRE only lasts a few seconds and the vast majority of people don’t experience any pain, just some mild discomfort. You lie on your side and the doctor inserts one gloved, lubricated finger into the rectum, feels your prostate, and then it’s done.
The doctor performing the DRE isn’t thinking about anything other than trying to work out if anything is out of the ordinary for the sake of your health – they’re not judging you, making assumptions or anything even remotely in that vein. To a doctor, a bum is as unremarkable as an elbow – it’s just another part of your body!
What if I don’t want a DRE?
If you really don’t want a DRE, you do not have to have one. Your doctor shouldn’t force you to have one, and ultimately if you have any symptoms of prostate disease it’s really important that you don’t let a DRE put you off raising it with your GP. Prostate cancer is so much more treatable when it’s caught early and there are many other ways to detect it.
We encourage you to ask questions, discuss concerns openly with your doctor and take time to understand your options. Your doctor may explain that the DRE does serve a purpose as we mentioned earlier, but you do not have to have any tests that you do not consent to and you won’t be the first person to refuse a DRE if you choose to. You will likely be assessed using an online risk checker and a PSA test, and potentially an MRI too just to be safe. The bottom line is if you have any concerns about your prostate, don’t put off going to the doctors because you’re concerned about the DRE.
Other ways of assessing prostate risk
Today there are several different tools that doctors use to both assess your risk of prostate cancer and investigate prostate disease other than a DRE.
Online risk checkers
There are online risk calculators you can use to evaluate how at risk you are of developing prostate cancer, such as this one from Prostate Cancer UK. Doctors may also use a similar calculator or ask you these questions to assess your risk. The factors that are analysed are age, family history, ethnicity and urinary symptoms.
PSA blood test
You may have heard about the PSA test, which has been used as a version of screening for prostate cancer. It’s a regular blood test which analyses the levels of Prostate-Specific Antigen as it is common to see elevated PSA levels in men with prostate cancer. It is important to note however that an elevated PSA level does not automatically mean you have prostate cancer – some men naturally have elevated PSA levels, but if this has been consistently elevated over time it could still be normal for you. If there is a sudden spike in your PSA result, this should trigger further investigation. Ultimately, everyone is different and PSA testing can’t definitively diagnose prostate cancer, but it can act as a signal for further testing.
MRI scan
An MRI would normally follow an abnormal PSA test result and/or DRE. It provides detailed images of the prostate without any invasive element. If you’ve not had one before, an MRI is a non-invasive scan that uses magnets and radio waves to create highly detailed images of the inside of your body.
Biopsy
If MRI imaging identifies a suspicious area within the prostate, a biopsy will be recommended. A biopsy is a procedure where a small sample of tissue is taken so that the cells can be analysed.
In the past, clinicians had to take somewhat of a scattergun approach, taking samples from multiple areas of the prostate to comprehensively analyse all prostate regions. Now thanks to developments in both imaging and prostate biopsy technique, biopsies can be much more targeted. Clinicians use MRI scans to pinpoint only the suspicious area, making the procedure much shorter. If you are referred for biopsy, don’t panic – it doesn’t mean you definitely have prostate cancer, and consultants often say that most men say after the procedure it was nowhere near as unpleasant as they thought it would be.
Fear of the unknown is usually the worst part...
In most cases, these changes are linked to benign prostate enlargement (BPE) or temporary inflammation rather than cancer.
The most important thing to take away from this is that if you’ve noticed changes, have symptoms or think you’re at high risk of prostate cancer, simply start the conversation – early detection saves lives. You have every right to ask questions and be a part of the conversation about your health, so don’t be afraid to speak up if you’re not comfortable.
