At first we must ask ourselves the question, “why is a prostate self-exam necessary?” Most men are reluctant to see doctors. We know that the digital rectal exam (DRE) can discourage some men from seeking preventive health checkups. The evidence, which is pretty conclusive on this point, is that whenever a hospital or clinic offers free prostate cancer screenings that include both the prostate-specific antigen (PSA) blood test and the DRE, rates of Participation by members of the surrounding communities are always much lower than if the PSA blood test is offered alone. So many more men will participate if only the PSA is offered.

Instead of bullying these men into “manning up” and enduring a humiliating ordeal, we can offer them an alternative. While some are skeptical about the value of prostate self-exams, the fact remains that these skeptics have no choice but to suggest other than harassing men to get their doctors to do prostate exams.

Prostate self-exams will have greater value and effectiveness when men are educated on how to perform these self-exams. Men have to learn how to do prostate exams by watching videos, available on the Internet, in which doctors demonstrate the technique. They also need to see dozens of diagrams of the prostate to know what to expect when they do their self-exam.

We already encourage all men, but especially those between the ages of 15 and 35, to perform a monthly testicular self-exam. If men can examine their own testicles, then they are likely to be mature enough to be able to examine their prostates once they learn how to do it and gain some experience examining their own prostates.

Men sometimes think that a doctor inserts a finger and then directly touches their prostates. That perception is not correct. The finger (or finger) is inserted through the rectum, but then the finger is located inside the intestine, which is separate and distinct from the prostate gland. Essentially, the doctor, or the patient in the case of self-exam, presses down on the wall of the intestine so that the posterior surface of the prostate gland can be felt under the wall of the intestine. However, the bowel wall effectively protects the prostate, so any suspicious nodules or areas must be large enough to be palpable through this cushion. Ideally, the examiner would like to be able to touch the surface of the prostate directly, but he has to do a close substitute for feeling it through the bowel wall.

Questions to remember

A normal prostate is about the size of a walnut. The prostates can enlarge to the size of a lemon. Possible causes of an enlarged prostate include benign prostatic hyperplasia or hormonal imbalance (too much estradiol or dihydrotestosterone) or prostatitis. As men age they enter a period we call Andropause; It is analogous to menopause in women. During Andropause, which normally lasts until the end of a man’s life, the body produces too little testosterone, resulting in an imbalance between testosterone and estrogen.

Estrogen levels in men are measured through the serum estradiol level. Both estradiol and dihydrotestosterone, the powerful form of testosterone, can irritate and cause an enlarged prostate. Elevated estradiol levels have been shown in clinical studies to cause prostate cancer; while dihydrotestosterone is known to accelerate the growth of prostate cancer, it does not appear to cause the cancer itself. A third explanation for why a prostate can become enlarged is if the patient has prostatitis.

The prostate feels similar to the pulp of an orange cut in half. If you feel something hard like the pit of an orange against the softer pulp, that would be a suspicious area for prostate cancer.

Important Points to Remember

For prostate self-exam, the finger should be inserted into the rectum with the palm of the hand facing down and the fingernail of the index finger facing up. It will feel much more natural, especially the first time you try this, insert your finger palm up and nail down. If you were to clean yourself with a bar of soap, you would naturally hold the soap with your palm facing up and your fingernails facing down. But you will need to learn to turn your hand so that your palm faces down and your fingernail faces up, so that you can feel the prostate with the pad of your finger rather than your fingernail. You will feel uncomfortable for at least the first five times you try to insert your finger in the correct position.

The prostate is not round in shape like a walnut, but more like the top of a heart-shaped object. Most men will find that they have a left lobe, a median lobe over which the urethra passes and effectively divides the prostate, and a right lobe. With a little practice, you’ll be able to tell which lobe you’re playing and any small differences between the lobes.

When performing a prostate self-exam at home, you will need to lean forward so that the prostate bulges out and can be more easily felt. If you stand up straight, your prostate will point downward (in the direction of your legs) and will be more difficult to feel with the digital rectal exam.

Get a more comprehensive prostate exam than you’re likely to get from a family doctor. Go over each available surface of the prostate at least three times, using a different circular motion each time. In the privacy of your own home, take at least one full minute and preferably two minutes to examine your prostate. Its objective is to be able to detect any cancerous nodule (hard surface) the size of a grain of rice. You won’t be able to feel a suspicious nodule in that degree of detail with a flick of your finger once over the prostate.

So when you go to the family doctor’s office and the doctor inserts a finger and moves it rapidly over the prostate, and the complete check takes three or four seconds, that’s not a detailed check of the prostate. Something that superficially failed to detect a cancer the size of a grain of rice. And that is your goal; their goal is always early detection while the prostate cancer is still small.

WARNINGS

Do not attempt prostate self-exams if you are not willing to take the time to learn how to check your prostate by reviewing clinical practice guidelines available on the Internet. Your health is at risk; trust yourself only if you have the intellectual ability to distinguish between normal and abnormal surfaces in soft tissues such as the prostate. If you think you will not be able to distinguish between normal and abnormal surfaces, you should not attempt this check yourself.

Prostate self-exam benefits

The patient can check the prostate more regularly than just once a year (early detection leads to earlier diagnosis and treatment). He can check your prostate quarterly or as often as he prefers given the state of your prostate, but it doesn’t have to be limited to an annual checkup.

Second, men who learn to perform prostate self-exams can avoid the discomfort and embarrassment that men often associate with a digital rectal exam. Third, men can visit the doctor more often without worrying about being asked to have a DRE or prostate check at every visit.

The interested reader should view the instructional video associated with this article. The video can be found at http://www.michaelguth.com/?p=1155