The first rectal exam, a procedure often referred to as a digital rectal exam (DRE), is commonly performed by a general practitioner or a doctor specializing in the urinary and reproductive systems, such as a urologist. This initial step is crucial for assessing any potential issues with the prostate, which is a small, walnut-shaped gland located just below the bladder in men. The doctor gently inserts a gloved and lubricated finger into the patient's rectum to manually feel the size, shape, and texture of the prostate gland. This allows for the detection of any abnormalities that could indicate the presence of conditions such as benign prostatic hyperplasia (BPH) or prostate cancer. The sensation of discomfort is usually brief and mild.
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Should the GP find any concerns, the patient may be referred to a urologist for further investigation. The urologist will likely conduct a transrectal ultrasound (TRUS), a more detailed diagnostic procedure that involves inserting an ultrasound probe into the rectum. This probe emits sound waves that bounce off the prostate, producing a clear and precise image of the gland's interior structures. The urologist can then examine the prostate more closely, checking for any signs of cancer, such as irregular growths or nodules.
If there is a suspicion of cancer, the patient may undergo a prostate biopsy, where a small sample of tissue is removed for laboratory analysis. This is typically done using a needle guided by the ultrasound image. The process may cause some discomfort, and the patient might experience temporary side effects such as bleeding or pain during urination.
Additional tests, like blood tests for prostate-specific antigen (PSA) levels or a magnetic resonance imaging (MRI) scan, may be ordered to provide further information and confirm the diagnosis. The MRI is particularly useful for identifying the precise location and extent of any tumor within the prostate gland, offering a three-dimensional view and helping to determine the most effective course of action.
If cancer is indeed confirmed, the patient will be staged according to the extent of the disease. This will guide the decision on whether surgery, radiation therapy, hormone therapy, or a combination of these treatments is necessary. The goal of these interventions is to remove the cancerous tissue, manage symptoms, and improve the patient's quality of life. The patient will work closely with their healthcare team to navigate the complexities of treatment options and make informed decisions based on their individual case.