Examination of the prostate by rectal touch

Identification and Diagnosis of Prostate Cancer

Rectal touch is the examination of the prostate carried out by the gloved finger of the doctor introduced into the rectum via the anus.
The level of PSA is given by a blood test for detection of prostate cancer.
However, the only way to confirm the presence of a prostate cancer is with a prostate biopsy. This is carried out under ultrasound guidance with an endo-rectal echography of the prostate in which an ultrasound probe is introduced into the rectum permitting the study of the prostate gland located just in front of it.

For early diagnosis of prostate cancer, the American Cancer Society recommends rectal touch and PSA tests for all men over 50 years. For high risk individuals (African origins or family history of prostate cancer) detection can be started at 40 years of age.
The French Urological Association recommends that men should be invited or allowed to take individual tests for prostate cancer on the same terms.

Examination of the prostate by rectal touch

Examination of the prostate by rectal touch

To carry out rectal touch, the doctor introduces his index finger covered by a lubricated glove into the rectum to feel the outer face of the prostate.

The examination, while it may not be pleasant, is completely painless, unless the patient has anal problems such as a tear. These should be reported to the doctor before the examination.

The major part of the prostate cannot be reached by this examination but in examining the outer face, the doctor can identify areas which are abnormally firm or hard nodules.

This finding is abnormal because the prostate is normally smooth, elastic and round. However, feeling an anomaly by rectal touch does not necessarily indicate the presence of prostate cancer.

The blood test for PSA (prostate specific antigen) is used to measure the level of an enzyme normally produced exclusively by prostate cells.

PSA is not found in significant quantities in any other organ of the human body.
Small quantities of PSA are usually present in the blood and can be detected and measured by a simple blood test.

PSA levels higher than normal can be the result of prostate infections; hypertrophy with benign tumours or prostate cancer.
PSA is, in fact, specific to prostate tissue, not prostate cancer.

In other words, a minor or moderate rise in the PSA level does not always indicate the presence of a prostate cancer. SOften, however, high PSA levels indicate the presence of a developed prostate cancer spread through metastases to some distance.

A PSA level exceeding 4,0 ng/ml is abnormal but this does not automatically confirm the existence of prostate cancer. The age of the patient, the size of the prostate, a recent ejaculation or an infection of the prostate can all influence the PSA level.

On the other hand, a patient can have a normal PSA level and still have prostate cancer. For this reason, it is essential to carry out both rectal touch and PSA tests. They are the two instruments for early detection of prostate cancer.

At this point, it is necessary to consider prostate biopsies assisted by an endo-rectal ultrasound.
The only examination allowing confirmation of prostate cancer is a prostate biopsy.

An ultrasound examination in isolation is insufficiently accurate because it can miss the presence of at least 30% of real cancers. For this reason, if the evidence from rectal touch and PSA tests is sufficiently strong, biopsies are carried out even if the ultrasound results are normal.

Biopsy of the prostate with a pistol and guillotine needle

Biopsy of the prostate with a pistol and guillotine needle

The test consists of obtaining several samples (=cores) from the prostate of about 15 mm long and 1 mm width. A long needle designed for the operation is used. The samples are then studied by a specialist in anatomo-pathology to determine whether cancer is present.

The operation is carried out under local anaesthetic and is completely painless.

It lasts about 15 minutes in external consultation and hospitalisation is not necessary.

Discomfort is usually moderate. Antibiotic treatment is given for five days to limit the risks of infection.

Although rare, significant bleeding or a prostate infection can occur after a prostate biopsy.

On the other hand, it is usual to see coloured urine or traces of blood in the sperm in the days following biopsy. Some men have temporary problems with urination after a prostate biopsy.

Outcomes are not certain. A negative biopsy indicates that prostate cancer has not been found on the prostate tissue samples taken.
However, cancerous tissue may be present in other parts of the prostate. This applies to 15 to 25% of biopsies for which the urologist may recommend further biopsies in suspicious cases.

Since many prostate cancers are hidden in the interior of the gland, cancer can be missed even when many samples of prostate tissue have been taken.