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However, it shouldn’t be painful - if it is, say so! The exam usually doesn’t last very long, but it should be done slowly enough that the doctor can assess the size of the prostate, feel its lobes, and detect any bumps or hardness or changes in consistency from one side to the other. If you’ve had a DRE, you already know that it’s awkward and uncomfortable. There are no data showing one position is superior to the other. Others opt to have the patient lie on one side with one or both knees drawn up toward the chest. Some physicians prefer that the patient stand and bend at the waist, with his arms extended on the examination table. There are two schools of thought about the best position for the DRE. A firm knot suggests malignancy, but it can be a sign of other conditions, such as benign prostatic hyperplasia. A normal prostate is small - about an inch and a half from side to side - and feels smooth and rubbery. Because the prostate sits in front of the rectum, the doctor can feel part of it through the rectal wall. Feeling the prostateĭuring a digital rectal exam (DRE), the doctor inserts a lubricated, gloved finger into the rectum. It was negative, but the initial surge of relief was quickly tempered.
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In April 1999, Caruso had his first prostate biopsy. (See “Feeling the prostate,” below.) During one of these exams, the urologist noted that a small part of the prostate seemed slightly firmer than the rest, a possible sign of cancer. He soon saw a urologist, who monitored changes in his PSA and performed digital rectal exams. The next year, however, Caruso’s PSA had risen to 4.4 ng/dl. So neither doctor nor patient worried much about the finding. During a long ride, the bicycle seat can put a lot of pressure on the perineum, the area between the anus and the scrotum, which can raise the PSA level even when cancer isn’t present. In keeping with editorial policy, the patient’s physicians are not named.Ĭaruso and his doctor chalked it up to his daily bike rides. *Editor’s note: To protect his privacy, the patient’s name and some biographical details have been changed. The result - 3.9 ng/dl - raised some concern because it fell at the upper end of what was considered the normal PSA range: 0 to 4.0 ng/dl. Then a 57-year-old businessman and avid bicyclist, Caruso* hadn’t had any prostate problems, but he agreed that regular PSA screening was probably wise for someone his age. In 1997, Jeffrey Caruso’s physician recommended prostate-specific antigen (PSA) screening as part of Caruso’s annual checkup.